肺部感染 肺气肿 护理个案 护理措施

Abstract Background: This study will evaluate the effects of nursing intervention (NIV) on lung infection prevention (LIP) in patients with tracheotomy. Methods: The electronic databases of MEDLINE, Cochrane Library, EMBASE, Web of Science, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure will be retrieved from inception to the June 1, 2019 for randomized controlled trials investigating the effects of NIV on LIP in patients with tracheotomy without any language limitations. In addition, we will also search grey literature to avoid missing any potential studies. Two independent authors will perform study selection, data extraction, and risk of bias evaluation. Results: This study will investigate the effects of NIV on LIP in patients with tracheotomy. The primary outcome is incidence of lung infection. The secondary outcomes include pulmonary function, quality of life, and complications post-surgery. Conclusion: The results of this study will summarize recent evidence for the effects of NIV on LIP in patients with tracheotomy. No ethic approval is needed in this study, because it will not need any individual data. The results of this study will be published at a peer-reviewed journal.

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Introduction: ARI (Acute Respiratory Infection) is one of the most common problems experienced by toddlers. Symptoms such as cough with phlegm or dry cough and nasal congestion are clinical manifestations of ARI. This paper aims to determine the effect of eucalyptus oil inhalation therapy and the provision of ginger honey drink on toddlers ARI in RW 001 Grogol Village, Depok City. Method: Eucalyptus oil inhalation therapy and honey ginger drink administration were carried out for 3 meetings, where each meeting was carried out inhalation for ± 10-15 minutes and continued by giving honey ginger drink. Results: After the intervention, the results showed that there was a decrease in the sound of ronkhi in the lung lobe and the appearance of mucus coming out of the airway,, indicating that eucalyptus oil inhalation therapy and honey ginger drink can reduce ARI symptoms. It can be concluded that the provision of eucalyptus oil inhalation therapy interventions and ginger honey drinks can reduce ARI in toddlers. Conclusion: therefore community nurses are expected to provide complementary ARI therapy procedures to parents so that parents can apply the therapy when their toddler experiences ARI.

Thoracic surgery is the main surgical method for the treatment of respiratory diseases and lung diseases, but infections caused by improper care are prone to occur during the operation, which can induce pulmonary edema and lung injury and affect the effect of the operation and the subsequent recovery. Therefore, it is necessary to control the disease in time and adopt more scientific and comprehensive nursing measures. Based on the neural network algorithm, this paper constructs a neural network-based factor analysis model and applies the operating room management nursing to postoperative infection nursing after thoracic surgery and verifies the effect through the neural network model. The statistical parameters in this article mainly include the postoperative infection rate of thoracic surgery, patient satisfaction, postoperative rehabilitation effect, and complications. Through statistical analysis, it can be known that operating room management and nursing can play an important role in postoperative infection nursing after thoracic surgery, effectively reducing postoperative infection nursing after thoracic surgery, and improving the recovery effect of patients after infection.

Objective: This paper aims to explore the effect of individualized nursing intervention on patients with activetuberculosis (ATB) and latent tuberculosis infection (LTBI). Methods: The nursing study started in January 2020 and ended in January 2023. A total of 60 patients with ATB and LTBI were included, and they were divided into two groups according to the intervention schemes selected for control testing, each with 30 cases. The intervention program selected for group A was routine care, and for group B was individualized nursing. The proportion of adverse reactions, changes in the level of lung items, self-management outcomes and satisfaction were evaluated and compared. Results: After evaluating the proportion of adverse reactions, the total proportion of ATB and LTBI in group B was lower than that in group A (P < 0.05). Based on the evaluation and testing of the expiratory flow (EF), expiratory volume (EV), and vital capacity (VC) after the intervention, these levels in group B showed higher outcomes than those in group A (P < 0.05). The scores in terms of living habits, sleep, diet, and compliance in group B were higher than those in group A (P < 0.05). The total proportionof the satisfaction of ATB and LTBI patients in group B was higher than that in group A (P < 0.05). Conclusion: After the intervention of individualized nursing measures in patients with ATB and LTBI, it was found that it can not only play a positive role in the prevention and control of adverse reactions, but also improve their lung function, and promote their self-management, with good satisfaction level, thus it has high research and clinical application values.

This study was aimed at evaluating the application effect of pulmonary rehabilitation training under 5A nursing mode based on X-ray in elderly patients with chronic obstructive pulmonary disease (COPD). Then, 84 elderly patients with chronic obstructive emphysema were selected as the research subjects. COPD knowledge level questionnaire, caregiver self-efficacy scale (CSES), COPD assessment test (CAT), and 6-minute walking experiment (6MWD) were adopted, and the clinical application effect of pulmonary rehabilitation training and conventional nursing under 5A nursing mode was comprehensively compared. The results show that after two and four months of intervention, the average score of COPD knowledge level questionnaire in the test group was 27.43 points and 30.08 points, respectively, higher than that in the control group (P < 0.05). After two and four months of intervention, the number of patients with good compliance in the test group was remarkably improved, and the severity of airflow restriction in the test group was slower than that in the control group. In short, pulmonary rehabilitation training under 5A nursing mode based on X-ray can effectively improve the disease knowledge level, self-efficacy, and pulmonary rehabilitation training compliance of elderly COPD patients, which played an important role in improving the quality of life of patients and alleviating the degree of dyspnea of patients.

Background: Bronchopneumonia is an infection of the lower respiratory tract caused by bacteria, viruses, or fungi. Children are more susceptible to Bronchopneumonia because their immune systems are weak. Bronchopneumonia can cause complications such as emphysema, acute otitis media, atelectasis, emphysema, and meningitis if not treated immediately. This study aims to implement Nursing Care for patient An. N with bronchopneumonia in the Inpatient Room of RSPPN Panglima Besar Soedirman. Research Methods: This study aimed to evaluate the effectiveness of This study is a case study of pediatric nursing focusing on one case of Bronchopneumonia, which includes assessment, diagnosis, intervention, implementation, and evaluation. Results: The study showed nursing diagnoses including ineffective airway clearance related to airway hypersecretion, hyperthermia related to the disease process, risk of falling related to having fallen, and knowledge deficit related to lack of exposure to information. Nursing implementation was carried out according to problem priorities for 3x24 hours. Implementation of independent nursing care for ineffective airway clearance problems, patients underwent chest physiotherapy and positioning, there was improvement although complaints still existed, so the problem was partially resolved. The diagnosis of hyperthermia, risk of falling, and knowledge deficit were successfully resolved. Conclusion: Nursing care effectively improves bronchopneumonia patients’ condition through chest physiotherapy, positioning, and targeted family education.

Objective: To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery. Methods: A patient in our hospital, who had intracranial aneurysm rupture and hemorrhage and developed pulmonary embolism after clipping surgery, was selected as the research subject. Through multidisciplinary collaboration, standardized assessment and dynamic condition observation, various risks were identified early. Combined with the patient’s individual characteristics, a personalized nursing plan was formulated. During the treatment process, emphasis was placed on strengthening the patient’s airway management, closely monitoring various indicators, and preventing postoperative complications. Targeted nursing measures were adopted: reasonable airway humidification and effective lung care were used to gradually control the patient’s pulmonary infection; fluid balance management and individualized care were implemented to ensure the patient’s normal circulating blood volume, thereby optimizing cerebral perfusion and cerebral oxygenation. Since the patient had overlapping risk factors for bleeding and thromboembolic events, evidence-based nursing principles were followed for thromboembolism prevention, and anticoagulation strategies and nursing plans were dynamically adjusted to reduce the occurrence of postoperative complications. Results: The patient’s condition improved and was successfully discharged on the 22nd day after surgery, and then transferred to a local rehabilitation hospital for further treatment. At the 1-month follow-up after discharge, the patient recovered well; at the 3-month follow-up after discharge, the patient had recovered and returned home. Conclusion: The results show that standardized assessment and condition observation, multidisciplinary collaboration, and personalized nursing plans can significantly reduce the occurrence of postoperative complications and improve the patient’s prognosis. This nursing experience provides a reference for the nursing of similar patients in the future.

To explore the efficacy of the combined use of Qingfei Huayu decoction (QFHYD) and targeted nursing care in pediatric cases of Mycoplasma Pneumoniae pneumonia (MPP). One hundred and twenty pediatric cases of MPP admitted to our hospital from January 2021 to December 2022 were selected and randomly divided into control (n = 60) and experimental (n = 60) groups. The control group (CG) was treated with targeted nursing care in conjunction with conventional Western medicine, while the experimental group (EG) received QFHYD in addition to the CG’s treatment. Clinical efficacy, symptom relief time, and levels of inflammatory markers were recorded. Subsequently, a mouse model of MPP was established to investigate the effects of QFHYD on bacterial load in lung tissues, tissue damage, and the expression of members of the Notch pathway. The symptom relief times for cough, fever, and pulmonary rales were shorter in the EG than in the CG (all P < 0. 001). After treatment, interleukin-6 (IL-6) and IL-8 levels decreased in both groups, with the levels being lower in the EG (both P < 0. 001). Mouse model results showed that both azithromycin alone and in combination with QFHYD could reduce bacterial loads in bronchoalveolar lavage fluid and lung injury scores (all P < 0. 001), with the combination showing more significant effects. Furthermore, western blotting indicated significant reductions in the relative protein levels of Notch1 and Notch2 in mouse lung tissues, with the combination showing more significant effects (all P < 0. 001). In pediatric MPP, the combination of QFHYD and targeted nursing care can significantly enhance clinical efficacy, accelerate symptom relief, and improve the body’s inflammatory state. Based on animal studies, we speculate that the action of QFHYD may be related to the Notch pathway.

Introduction: Post-operative pulmonary complications (PPCs) such as pneumonia, atelectasis, and respiratory failure significantly impact surgical outcomes, especially among high-risk patients with pre-existing respiratory conditions, advanced age, or those undergoing major surgeries. Effective prevention of PPCs is critical for improving patient outcomes. Nursing care plays a pivotal role in this prevention through early mobilization, respiratory exercises, proper positioning, and vigilant monitoring.Objectives :This study investigates the effectiveness of nursing care in preventing PPCs among high-risk hospitalized patients.Methods: A descriptive case study design was used, involving 15 patients from a multispecialty hospital in Trivandrum who met the inclusion criteria of having more than four risk factors for PPCs and consented to participate. Data collection tools included demographic variables, clinical manifestation checklists, risk factors for PPCs, and an individualized nursing care plan. Over six weeks, patients were selected through convenience sampling and a 24-hour nursing care plan was implemented. Descriptive statistics were used for data analysis. Results: The study sample consisted predominantly of elderly patients (73.3% aged above 60 years), with males constituting 66.7%. Significant risk factors included smoking history (66.7%) and elevated BMI (53.3%). All surgeries were performed under general anesthesia, with 60% lasting over 3-4 hours. Nursing interventions included deep breathing and coughing exercises, frequent position changes, early ambulation, use of an incentive spirometer, prophylactic antibiotics, and strict aseptic techniques. Most severe PPC symptoms were absent; however, mild symptoms like elevated temperature and cough were observed in 20% of patients. Discussion: The results indicate that the comprehensive nursing care strategies effectively prevented most significant PPCs. The absence of severe symptoms suggests the success of interventions such as early mobilization and respiratory exercises. The occurrence of mild symptoms in some patients highlights the need for ongoing refinement of nursing protocols. Conclusion: Effective nursing care significantly reduces PPC incidence in high-risk postoperative patients. This study supports the development of best practice guidelines for nursing care, emphasizing individualized care plans to improve patient outcomes and ensure high-quality healthcare services.

Objective: To explore the value of receiving personalized comprehensive care for patients with severe pneumonia. Methods: 73 patients with severe pneumonia who visited the clinic from February 2020 to February 2023 were included in this study. The patients were randomly grouped into Group A and Group B. Group A received personalized comprehensive care whereas Group B received conventional care. The value of care was compared. Results: The duration of mechanical ventilation time, the time taken for fever and dyspnea relief, and the hospitalization time of Group A were shorter than those in Group B (P < 0.05). The blood gas indexes such as PaO2, PaCO2, and blood pH of Group A were better than those of Group B (P < 0.05). The pulmonary function indexes such as peak expiratory flow (PEF), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) of Group A were better than those of Group B, P < 0.05. Moreover, the patients in Group A were generally more satisfied with the care given compared to the patients in Group B (P < 0.05). Conclusion: Personalized comprehensive care improves blood gas indexes, enhances lung function, accelerates the relief of symptoms, and also enhances patient satisfaction in severe pneumonia patients.

Background: Aspiration pneumonia (AP) is a severe pulmonary infection resulting from the inhalation of oropharyngeal or gastric contents, leading to significant morbidity and mortality, particularly in intensive care units (ICUs). Distinguishing AP from aspiration pneumonitis is critical, as their management differs substantially. High-risk populations include elderly, neurologically impaired, and mechanically ventilated patients.Aim: This review evaluates evidence-based nursing and medical interventions for AP management, focusing on prevention, early diagnosis, and treatment strategies to improve clinical outcomes.Methods: A critical review of current literature was conducted (50 scanned, and 14 selected), analyzing risk factors, diagnostic approaches, medical treatments, and nursing interventions for AP. Emphasis was placed on multidisciplinary care, including pharmacological management, swallowing assessments, and respiratory support.Results: Key findings highlight the importance of early antibiotic therapy, with amoxicillin, ampicillin-sulbactam, and respiratory fluoroquinolones as primary treatments. Non-pharmacological strategies, such as swallowing evaluations, dietary modifications, and oral hygiene, significantly reduce AP risk. Nursing interventions, including airway management, positioning, and continuous monitoring, are vital in preventing complications.Conclusion: Effective AP management requires a multidisciplinary approach integrating prompt antibiotic therapy, risk factor modification, and vigilant nursing care. Early recognition and preventive measures can reduce mortality and improve patient outcomes.

It has been reported that the incidence of nosocomial infections in the ICU is about 2–5 times higher than in the general in-patient hospital population. The study's objective was to evaluate the effectiveness of Nursing Strategies on Risk for Pneumonia among Patients connected to Mechanical Ventilator in Intensive Care Unit. The study adopted randomized controlled trial. Forty patients were enrolled in the study after screening using CPIS scale. If the score <6 the patients were included in the study and eligibility criteria were age between 25 to 60 years, duration of ventilator 48 hours and medical patients with respiratory, renal, MODS, and sepsis diagnosis. Patients subjected to surgery and connected with non-invasive ventilation were excluded from the study. Standardized questionnaire such as demographic variables, clinical variables, and Clinical Pulmonary Infection Scoring (CPIS). The data was analyzed using descriptive statistics, independent ‘t’ test, paired t test and ANOVA were used to analyze the data. Seven (35%) of them were in the age group of 51-60 years in the study group, whereas six (30%) of the patients were in the age group of 61-70 years in the control group. 12(60%) of the patients were male and eight (40%) of them were female in the study group and 10(50%) of patients were male and female respectively in the control group. Regarding mode of ventilation, 12(50%) and six (30%) of patients ventilator setting were CMV and ASV respectively, in the study group, whereas seven (35%) and six (30%) of patients ventilator settings were ASV and CMV respectively in the control group. The pretest CPIS mean score was 4.40 with a standard deviation of 0.59 and the posttest III mean value was 2.60 with a standard deviation of 0.58 and the mean difference was 1.80 between the pretest and the posttest III, which was statistically significant at p<0.001 in the study group. Nursing strategies such as demand suctioning, second hourly position change, changing ventilator flow sensor every 72 hours, and oral care every fourth hour with chlorhexidine help reduce ventilator-associated pneumonia.

Perioperative nursing care for patients with neuromuscular disorders, especially spinal muscular atrophy (SMA), remains a challenge. There is an obvious lack of guidelines. We retrospectively reviewed the medical charts of patients with type II or III SMA who underwent spinal surgery from 2018 to 2022. Nursing assessments included muscle strength, pulmonary function, the Barthel Index, the Braden Scale, Nutrition Risk Screening 2002, and the Hamilton Anxiety Scale. Preoperative and postoperative anxiety levels were compared using a paired-samples t-test. All 24 included patients had severe scoliosis, kyphosis, or kyphoscoliosis, with a mean Cobb angle of 102 degrees. Upon admission, all patients (24/24) presented with muscle weakness, were classified as having total or severe dependency, and were at risk of developing pressure sores; 58.3% (14/24) of the patients had severe pulmonary function impairment, and 50.0% (12/24) were at nutritional risk, with the score unable to be assessed in 8.3% (2/24) of the patients. All patients underwent posterior spinal fusion surgery with bone grafting. Only one patient experienced a major postoperative complication, pneumonia, which was effectively managed. Anxiety level decreased significantly (P < 0.01) at discharge compared to that on admission. Complementing regular nursing care, an SMA-specific perioperative nursing care protocol was implemented: (1) Respiratory care protocol: A. Confirmation of SMA type; B. Comprehensive evaluation of symptoms, signs, and pulmonary function test results; C. Development and implementation of a personalized plan including: Plan 1. Training on respiratory function including diaphragmatic breathing exercise, coughing exercise, inhaling exercise, and exhaling exercise; Plan 2. Use of cough assist device, and/or Plan 3. Use of non-invasive ventilator. (2) Postoperative three-step all-involved training protocol of postural adaptation from nurse-led to caregiver-led and inducing patient self-advocacy: A. Preparation for the training; B. Postural adaptation training; C. Postural switch from lying to sitting. We implemented an SMA-specific perioperative nursing care protocol, including a respiratory care protocol and a postoperative three-step all-involved training protocol of postural adaptation, complementing standard nursing care. Our approach yielded positive patient outcomes, while we acknowledge the limitation that our protocol is pending comparative evaluations due to the rarity of the disease. The protocol was initially designed for patients with SMA but may also be suitable for other patients with profound muscle weakness.

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Background : This study aims to evaluate the effects of comprehensive nursing based on the “3H” theory on blood gas parameters, recovery speed and lung function in children with severe pneumonia. Methods : An analysis was conducted on clinical data from 90 children diagnosed with severe pneumonia who were treated at our hospital between November 2022 and December 2023. They were randomly divided into two groups based on the computer random number table method: a study group, which received comprehensive nursing based on the “3H” theory in addition to routine care (n = 45), and a control group, which received only routine care (n = 45). The recovery speed, blood gas indexes, lung function indexes, and family satisfaction were compared between the two groups. Results : Before treatment, there were no significant differences between the two groups in terms of arterial partial pressure of oxygen (PaO 2 ), arterial oxygen saturation (SaO 2 ), arterial partial pressure of carbon dioxide (PaCO 2 ), forced expiratory volume in 1 second (FEV 1 ), forced vital capacity (FVC), maximum voluntary ventilation (MVV), peak expiratory flow (PEF) and the ratio of FEV 1 to FVC (FEV 1 /FVC) ( p > 0.05). After treatment, the study group showed higher compliance, family satisfaction, FEV 1 , FVC, MVV, PEF, PaO 2 and SaO 2 levels, and shorter times for cough relief, fever reduction, improvement in shortness of breath, disappearance of lung rales, hospitalization and PaCO 2 levels. These differences were all statistically significant ( p < 0.05). Conclusions : Comprehensive care under the “3H” theory can significantly improve the recovery speed, blood gas levels, pulmonary function and family satisfaction in children with severe pneumonia. The ISRCTN Registration : ISRCTN13393172.

Background Although head elevation is an early first-line treatment for elevated intracranial pressure (ICP), the use of the head-down or prone position in managing neurocritical patients is controversial because a change in a position directly affects the intracranial and cerebral perfusion pressure, which may cause secondary brain injury and affect patient outcomes. This study compared the effects of two postural drainage positions (30° head-up tilt and 0° head flat) on the prognosis of neurocritical care patients with complicated pneumonia and a clinical pulmonary infection score (CPIS) ≥5 points to provide a reference for selecting appropriate postural drainage positions for patients with pneumonia in neurocritical care units. Methods A prospective randomized controlled study was conducted with 62 neurocritical care patients with complicated pneumonia. The patients were categorized into control (=31) and experimental (=31) groups in a 1:1 ratio using a simple randomized non-homologous pairing method. Emphasis was placed on matching the baseline characteristics of the two groups, including patient age, sex, height, weight, Glasgow Coma Scale score, heart rate, mean arterial pressure, cough reflex, and mechanical ventilation usage to ensure comparability. Both groups received bundled care for artificial airway management. The control group maintained a standard postural drainage position of 0° head-flat, whereas the experimental group maintained a 30° head-up tilt. The efficacy of the nursing intervention was evaluated by comparing the CPIS and other therapeutic indicators between the two groups after postural drainage. Results After the intervention, the within-group comparison showed a significant decrease in the CPIS (P < 0.001); procalcitonin levels showed a significant decreasing trend (P < 0.05); the arterial oxygen pressure significantly increased (P < 0.05); the oxygenation index significantly increased (P < 0.001); and the aspiration risk score showed a significant decreasing trend (P < 0.001). A between-group comparison showed no significant differences in any of the indicators before and after the intervention (P < 0.05). Conclusion Postural drainage positions of 30° head-up tilt and 0° head-flat can improve the CPIS and oxygenation in patients without adverse effects. Therefore, we recommend that patients under neurological intensive care and having pneumonia be drained in a 30° head-up tilt position with good centralized care of the lung infection. Trial registration The study, “Study of Angles of Postural Drainage in Neurocritical Patients with Pneumonia,” was registered in the Protocol Registration Data Element Definitions for Interventional Study database (# ChiCTR2100042155); date of registration: 2021-01-14.

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Aims/Background Noninvasive intermittent positive pressure ventilation is a widely used approach for managing Chronic obstructive pulmonary disease (COPD) complicated with respiratory failure. Treatment procedures often result in severe complications, requiring the implementation of proactive and effective nursing measures. Therefore, this study investigated the impact of failure mode and effects analysis (FMEA) on preventing complications in COPD patients with respiratory failure and assessed its influence on negative emotions, hope level, and quality of life. Methods This retrospective study included 356 patients with COPD combined with respiratory failure who underwent treatment in the First Affiliated Hospital of Wenzhou Medical University, China, between January 2023 and December 2023. Patients receiving usual care were included in the care-as-usual (CAU) group (n = 204), and those who underwent FMEA were assigned to the FMEA group (n = 152). Baseline characteristics and clinical data were compared between the two groups. Furthermore, the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Herth Hope Index (HHI) and 36-item Short-Form were collected and comparatively analyzed between the two groups. Results The FMEA group exhibited a significantly lower incidence of facial compression injury, dry mouth, phlegm obstruction, flatulence, bronchiectasis, and aspiration pneumonia than the CAU group (p < 0.05). After the intervention, the SAS and SDS scores were significantly reduced in the FMEA group than in the CAU group (p < 0.001). The temporality and future, positive readiness and expectancy, inter-connectedness, and HHI scale total scores were significantly higher in the FMEA group compared to the CAU group (p < 0.05). The physiological function, role-physical, body pain, general health perceptions, vitality, social functioning, role-emotional, and mental health of patients were significantly higher in the FMEA group than in the CAU group (p < 0.05). Conclusion The application of the FMEA nursing approach helps reduce the risk of complications in patients with COPD combined with respiratory failure, while effectively reducing anxiety and depression, improving their hope level and enhancing their overall quality of life. These observations offer a basis for preventing complications, and provide a reference for the formulation of nursing plans for these patients in clinical practice.

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Background Providing intensive care is increasingly expensive, and the aim of this study was to construct a risk column line graph (nomograms)for prolonged length of stay (LOS) in the intensive care unit (ICU) for patients with chronic obstructive pulmonary disease (COPD). Methods This study included 4,940 patients, and the data set was randomly divided into training (n = 3,458) and validation (n = 1,482) sets at a 7:3 ratio. First, least absolute shrinkage and selection operator (LASSO) regression analysis was used to optimize variable selection by running a tenfold k-cyclic coordinate descent. Second, a prediction model was constructed using multifactorial logistic regression analysis. Third, the model was validated using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow tests, calibration plots, and decision-curve analysis (DCA), and was further internally validated. Results This study selected 11 predictors: sepsis, renal replacement therapy, cerebrovascular disease, respiratory failure, ventilator associated pneumonia, norepinephrine, bronchodilators, invasive mechanical ventilation, electrolytes disorders, Glasgow Coma Scale score and body temperature. The models constructed using these 11 predictors indicated good predictive power, with the areas under the ROC curves being 0.826 (95%CI, 0.809–0.842) and 0.827 (95%CI, 0.802–0.853) in the training and validation sets, respectively. The Hosmer-Lemeshow test indicated a strong agreement between the predicted and observed probabilities in the training (χ2 = 8.21, p = 0.413) and validation (χ2 = 0.64, p = 0.999) sets. In addition, decision-curve analysis suggested that the model had good clinical validity. Conclusion This study has constructed and validated original and dynamic nomograms for prolonged ICU stay in patients with COPD using 11 easily collected parameters. These nomograms can provide useful guidance to medical and nursing practitioners in ICUs and help reduce the disease and economic burdens on patients.

The global population is aging at an unprecedented rate, resulting in a growing and vulnerable elderly population in need of efficient comprehensive healthcare services that include long-term care and skilled nursing facilities. In this context, severe aspiration pneumonia, a condition that carries substantial morbidity, mortality, and financial burden, especially among elderly patients requiring admission to the intensive care unit, has attracted greater concern. Aspiration pneumonia is defined as a pulmonary infection related to aspiration or dysphagia in etiology. Prior episodes of coughing on food or liquid intake, a history of relevant underlying conditions, abnormalities on videofluoroscopy or water swallowing, and gravity-dependent shadow distribution on chest imaging are among the clues that suggest aspiration. Patients with aspiration pneumonia tend to be elderly, frail, and suffering from more comorbidities than those without this condition. Here, we comprehensively address the epidemiology, clinical characteristics, diagnosis, treatment, prevention, and prognosis of severe aspiration community-acquired pneumonia in the elderly to optimize care of this high-risk demographic, enhance outcomes, and minimize the healthcare costs associated with this illness. Emphasizing preventive measures and effective management strategies is vital in ensuring the well-being of our aging population.

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Abstract Introduction: Since the end of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected more than 1,000,000 population in the world. Subcutaneous emphysema and pneumothorax are uncommon complications of SARS-CoV-2 pneumonia. Herein, we describe a fatal case of SARS-CoV-2 pneumonia with subcutaneous emphysema and pneumothorax. Patient concerns: Subcutaneous emphysema was found in neck, bilateral chest walls, abdomen wall, groin area, and scrotum of a 67-year-old man. Extensive air-space opacities, subcutaneous emphysema and a small amount of pneumothorax were found in his chest X-ray scan. Echocardiography showed left ventricular enlargement with ejection fraction 20%. Diagnosis: This resident of Wuhan with laboratory-confirmed SARS-CoV-2 infection had chronic pulmonary and cardiac diseases. Liver dysfunction, myocardial injury, and coagulation disorder were suggested by laboratory findings. Pneumonia, subcutaneous emphysema, and pneumothorax were confirmed with chest X-ray. Heart failure was revealed by echocardiography. Interventions: He was transferred to intensive care unit, where invasive ventilation was used for him during the whole hospitalization. Prone position ventilation, vasoconstrictor, antibacteria, and antiviral therapy were given. Outcomes: He died on the twelfth day after admission. Conclusions: Subcutaneous emphysema and pneumothorax may occur in patients with SARS-CoV-2 pneumonia and chronic pulmonary disease. Chronic cardiac disease might be aggravated by SARS-CoV-2 infection, and develop heart failure.

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Submitted August 7, 2018; accepted September 17, 2018. O steopathic diagnosis and management of rib dysfunction may be beneficial to patients with respiratory disorders such as pneumonia, asthma, chronic obstructive pulmonary disease (COPD), and emphysema. Chronic obstructive pulmonary disease, which is a major public health threat and a significant cause of morbidity and mortality, causes airflow limitations due to damage to airway and lung anatomical structures. Symptoms typically include cough, shortness of breath, and production of sputum. Pharmacologic treatment for patients with COPD targets the pathology within the lung, bronchus, and alveoli itself and includes bronchodilators, inhaled or oral steroids, or antibiotics, if needed. Further prevention and treatment focuses on reducing flares by means of risk factor modifications, smoking cessation, vaccinations, pulmonary rehabilitation, physical activity, nutritional support, and oxygen supplementation, if needed. Respiration is a biomechanical endeavor, and adequate respiration requires the normal motion of the diaphragm, ribs, and sternum. These structures move so as to increase or decrease the size of the thorax, generating the positive and negative pressures necessary for respiration. Ribs 1-5 move in a mostly pump handle motion, ribs 6-10 in a bucket handle motion, and ribs 11-12 in a pincertype motion. Diseases such as COPD that alter the size and shape of the thorax (including hyperinflation of the lungs and an increased anterior/ posterior diameter) have a significant effect on anatomical structures and respiratory mechanics. The diaphragm, which connects to ribs 6-12, becomes flattened with altered length tension relationships, decreasing its ability to contract and its inspirational efficiency. Osteopathic manipulative treatment (OMT) may be beneficial for patients with COPD through its effect on the musculoskeletal aspects of the thoracic cage. Somatic dysfunction may impede function in the work of respiration. Diagnosis of somatic dysfunction in the ribs, thoracic spine, diaphragm, and accessory muscles of respiration should be performed. A review of the literature has demonstrated few studies with mixed benefit from OMT in patients with COPD. One small study found that OMT in conjunction with pulmonary rehabilitation improved exercise capacity (6-minute walk test) and reduced residual volume over pulmonary rehabilitation alone. Careful consideration must be taken: one study demonstrated an increase in residual volume attributed to the active component of the thoracic lymphatic pump, which promotes a large inhalation. One technique that may be used to improve rib somatic dysfunction is balanced ligamentous tension (video). This gentle technique can easily be used in the office or hospital setting as a direct or indirect technique in any age group. Diagnosis can first be made in the seated or supine position by observing quiet respiration and looking for areas of decreased rib motion. A gentle springing motion can then be used on each rib to assess for compliance and ability to move. The bucket handle, pump handle, and caliper ribs may be assessed for motion in inhalation and exhalation, with the operator looking for inhaled rib dysfunctions (those that remain inhaled during the patient’s active exhalation) or exhaled rib dysfunctions (those that remain in exhalation during the patient’s active inhalation). Contraindications for balanced ligamentous tension include fracture of the rib, bony metastasis, and infection, postsurgical sites, arterial lines, or drains near the area. This OMT technique is very gentle and uses rib biomechanics and inherent forces, including respiration, to restore motion, improve respiratory mechanics, and potentially OMT MINUTE

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Purpose We investigated the effect of pulmonary rehabilitation (PR) on airway resistance in chronic obstructive pulmonary disease (COPD) patients with severe airway obstruction and hyperinflation. Patients and Methods This retrospective cohort study was conducted with data from severe COPD cases with those who underwent an 8-week PR program. Main inclusion criteria were having severe airflow obstruction (defined as a forced expiratory volume in one second (FEV1) <50%) and plethysmographic evaluation findings being compatible with hyperinflation supporting the diagnosis of emphysema (presence of hyperinflation defined as functional residual capacity ratio of residual volume to total lung capacity (RV/TLC) >120%). Primary outcomes were airway resistance (Raw) and airway conductance (Gaw) which were measured by body plethysmography, and other measurements were performed, including 6-minute walk test (6-MWT), modified Medical Research Council dyspnea scale (mMRC) and COPD assessment test (CAT). Results Twenty-six severe and very severe COPD patients (FEV1, 35.0 ± 13.1%; RV/TLC, 163.5 ± 29.4) were included in the analyses, mean age 62.6 ± 5.8 years and 88.5% males. Following rehabilitation, significant improvements in total specific airway resistance percentage (sRawtot%, p = 0.040) and total specific airway conductance percentage (sGawtot%; p = 0.010) were observed. The post-rehabilitation mMRC scores and CAT values were significantly decreased compared to baseline results (p < 0.001 and p < 0.001, respectively). Although there were significant improvements in 6-MWT value (p < 0.001), exercise desaturation (ΔSaO2, p = 0.026), the changes in measured lung capacity and volume values were not significant. Conclusion We concluded that PR may have a positive effect on airway resistance and airway conductance in COPD patients with severe airflow obstruction.

Background: Difficult weaning from mechanical ventilation in ICU patients prolongs hospitalization and increases risks of complications like ventilator-associated pneumonia and ICU-acquired weakness. While standard care (airway management and early functional exercise) is routine, outcomes remain suboptimal. This study evaluated a nurse-led, goal-directed pulmonary rehabilitation program to improve weaning success, reduce weaning time, and enhance physiological/functional recovery in this high-risk population. Methods: Using convenience sampling, 70 ICU patients with difficult weaning (admitted August 2023–July 2024) were divided into historical control and observation groups (35 each). The control group (August 2023–January 2024) received standard airway care and early functional exercise. The observation group (February–August 2024) received additional nurse-led pulmonary rehabilitation, including individualized goal setting, progressive respiratory training (using continuous positive airway pressure/synchronized intermittent mandatory ventilation protocols), daily sedation–pain–agitation monitoring (Richmond Agitation-Sedation Scale/Care Pain Observation Tool), and muscle strengthening guided by the ICU Mobility Scale. Outcomes compared included weaning success rate, weaning time, oxygenation index (PaO₂/FiO₂), muscle strength (Medical Research Council scale), and self-care ability (Barthel Index), with statistical significance set at P < .05. Results: The observation group demonstrated significantly higher weaning success rates and shorter weaning times versus controls (P < .05). While pre-intervention oxygenation indices showed no difference (P > .05), post-intervention PaO₂/FiO₂ ratios were significantly higher in the observation group (P < .05). Muscle strength (Medical Research Council scores) and self-care ability (Barthel Index scores) also showed statistically significant improvements in the intervention group after treatment (P < .05). Conclusion: The nurse-led, goal-directed pulmonary rehabilitation program significantly accelerates weaning, increases success rates, and improves oxygenation, muscle strength, and self-care ability in difficult-to-wean ICU patients. It represents an effective enhancement to standard care and is recommended for broader clinical implementation.

This case report discusses the physiotherapy management of an adult patient with chief complaints of breathlessness and difficulty expelling out mucus for the past month, with a history of multiple hospitalizations due to recurrent respiratory infections, who was diagnosed as bronchiectasis. In this study, the patient was treated with a combination of the RC-Cornet PLUS (CEGLA Medizintechnik, Montabaur, Germany), an oscillatory positive expiratory pressure (OPEP) device used for airway clearance, and the POWERbreathe Medic Plus (POWERbreathe, England, UK), an inspiratory muscle training (IMT) device, along with tailored pulmonary rehabilitation. Pulmonary rehabilitation focused on patient education, breathing exercises, airway clearance techniques (ACTs), endurance training, strengthening, and energy conservation techniques. The RC-Cornet PLUS device further complemented these interventions and facilitated effective mucus clearance, while the POWERbreathe Medic Plus device aided in improving respiratory muscle strength and endurance. Through this comprehensive approach, significant improvement in dyspnea was observed from grade 3 to grade 1 on the Modified Medical Research Council (MMRC) scale, improvement in inspiratory muscle strength was observed from 9 cmH2O to 12 cmH2O, there was an increase in functional capacity using a six-minute walk test distance from 60 meters to 190 meters, and improvement in the quality of life was observed on the WHO Quality of Life scale from 50% to 52.5% just after two weeks. The study concludes that adding the RC-Cornet PLUS device and POWERbreathe Medic Plus device to the standard pulmonary rehabilitation protocol improves functional capacity and quality of life in bronchiectasis patients.

Background Chronic obstructive pulmonary disease (COPD) is characterized by airway inflammation, airflow limitation, reduced health-related quality of life (HRQL), and exercise intolerance. Pulmonary rehabilitation (PR) is essential for COPD management, but outcomes may be influenced by individual physiological factors. Cardiopulmonary exercise testing (CPET) measures oxygen pulse (O2P), an indicator of stroke volume, yet the impact of baseline O2P on PR effectiveness remains unclear. Methods This retrospective study included 97 participants with COPD who had received PR, of whom 48 were classified as Group 1 (normal O2P) and 49 as Group 2 (low O2P). PR involved 12 weeks of hospital-based endurance training on a bike, performed twice a week. Participants were assessed before and after PR using spirometry, respiratory muscle strength measurements, CPET, and HRQL evaluation with the St. George’s Respiratory Questionnaire (SGRQ). Results PR significantly improved exercise capacity (peak work rate and oxygen consumption), dyspnea score, and all domains of the SGRQ, maximum expiratory pressure, ventilatory equivalent, respiratory rate, and mean blood pressure at rest in both groups (p < 0.05). However, improvements in O2P, maximal inspiratory pressure, and tidal volume at rest were observed only in Group 2 but not in Group 1. Conclusion PR improves exercise capacity, HRQL and specific respiratory function in participants with COPD, regardless of baseline O2P levels. Individuals with lower baseline O2P experience more benefits from PR, including a significant increase in O2P.

Chronic lung diseases (CLDs) in children, such as asthma, cystic fibrosis, and bronchopulmonary dysplasia, significantly impact respiratory function and overall quality of life. Exercise-based pulmonary rehabilitation (PR) has emerged as a multidisciplinary approach to improving lung function, exercise capacity, and reducing hospitalization rates. This study assessed the effectiveness of a structured PR program in pediatric patients with CLDs in Damietta Governorate, Egypt. A randomized controlled trial was conducted with 400 pediatric patients with CLDs (aged 6–16 years) divided equally into intervention and control groups. The intervention group underwent a 12-week exercise-based PR program incorporating respiratory training, airway clearance techniques, and physical therapy, while children in the control group received standard medical care consisting of routine follow-ups, medication management, and lifestyle counseling without structured rehabilitation exercises. Post-intervention results demonstrated significant improvements in forced expiratory volume (FEV1), forced vital capacity (FVC), peak expiratory flow, six-minute walk test (6MWT), and quality of life scores (p < 0.001). Additionally, hospitalization frequency and medication dependency were significantly reduced (p < 0.001). The findings reveal that exercise-based PR significantly improves pulmonary function, exercise tolerance, and overall quality of life in children with chronic lung diseases. Additionally, PR effectively reduces hospitalization rates and medication dependency, offering a sustainable approach to disease management.

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In respiratory physiology, mucus secretion is crucial in trapping foreign particles, bacteria, and viruses, preventing their entry into the body. Various respiratory conditions like chronic respiratory diseases or infections necessitate effective sputum expectoration because inadequate clearance can lead to complications due to retained secretions in the airways. This review discusses various pulmonary rehabilitation methods for sputum expectoration, facilitating mucus loosening/mobilization, and cough expulsion. Mucus loosening and mobilization can be achieved by postural drainage, several breathing techniques, positive expiratory pressure (PEP), oscillating PEP, and vibration methods (via external chest wall or direct airway). The latter methods include huffing, manual assist cough, mechanical in-exsufflation, and artificial glottic device. Each method's efficacy and applicability vary based on patient-specific factors and should be tailored accordingly for optimal management of sputum clearance.

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Background Pulmonary Rehabilitation (PR) is one of the most cost-effective therapies for chronic obstructive pulmonary disease (COPD) management. There are, however, people who do not respond to PR and reasons for non-response are mostly unknown. PR is likely to change the airway microbiota and this could play a role in its responsiveness. In this study we have explored the association between PR effectiveness and specific alterations in oral microbiota and inflammation. Methods A prospective longitudinal study was conducted. Data on exercise capacity, dyspnoea, impact of disease and 418 saliva samples were collected from 76 patients, half of whom participated in a 12-weeks PR programme. Responders and non-responders to PR (dyspnoea, exercise-capacity and impact of disease) were defined based on minimal clinically important differences. Results Changes in microbiota, including Prevotella melaninogenica and Streptococcus were observed upon PR. Prevotella , previously found to be depleted in severe COPD, increased during the first month of PR in responders. This increase was negatively correlated with Streptococcus and Lautropia , known to be enriched in severe cases of COPD. Simultaneously, an anti-inflammatory commensal of the respiratory tract, Rothia, correlated strongly and negatively with several pro-inflammatory markers, whose levels were generally boosted by PR. Conversely, in non-responders, the observed decline in Prevotella correlated negatively with Streptococcus and Lautropia whose fluctuations co-occurred with several pro-inflammatory markers. Conclusions PR is associated with changes in oral microbiota. Specifically, PR increases salivary Prevotella melaninogenica and avoids the decline in Rothia and the increase in Streptococcus and Lautropia in responders, which may contribute to the benefits of PR.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a complex lung disorder marked by persistent respiratory symptoms such as breathlessness, cough and sputum production due to airway and/or alveolar damage. Methods: A quasi-experimental pretest-posttest design was employed, assessing 10% of the projected sample size (n = 200) using convenience sampling at Saveetha Medical College and Hospitals, Chennai. The experimental group received a three-month intensive PR program in addition to standard medical care per GOLD guidelines, while the control group received only standard care. The intervention included education on COPD management, breathing exercises, physical training and psychological support. Outcomes were measured at just before starting the study, 6th week and 12th week using 6-Minute Walk Test (6MWT). Results: Both the groups were comparable at just before the study initiation regarding clinical and demographic characteristics. The experimental group showed a significant increase in 6MWT distance over 12 weeks (from 320±45 m to 400±48 m; F = 42.18, p<0.001), whereas the control group exhibited only minimal improvement. Conclusions: A comprehensive pulmonary rehabilitation program significantly improved the exercise capacity in COPD patients regardless of demographic or clinical variables, highlighting its importance as an adjunct to standard medical treatment.

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity, mortality, and health care use. COPD -Chronic obstructive pulmonary Disease (COPD), a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to the noxious particles or gases. Objectives: To evaluate the effectiveness of Yoga Therapy in the management of dyspnea and fatigue in patients with COPD. Inclusion criteria: 1. Age > 18 years. 2. History, examination and PFT consistent with COPD as per GOLD guidelines. PFT showing: -FEV1/FVC < 0.70 -irreversible bronchial obstructions (<12% and /or <200ml increase in FEV1 or FVC, 20 minutes after the administration of 200μg of inhaled salbutamol). Exclusion criteria: 1. History of acute respiratory tract infection in the past 4 weeks prior to study. 2. History of medication with antibiotics and /or steriods (oral, injection or inhalation) in the previous 4 weeks prior to study. 3. Patients with cardiovascular disease, diabetes mellitus, Neuro -masculo-skeletal deficits, tuberculosis, hepatic or renal diseases. 4. Pregnant and lactating females. 5. History of thyroid disorders, parathyroid disorder and thyroidectomy. Materials and methods: A randomised controlled trial at New Delhi India hospital a Tertiary care unit:Sixty COPD patients (18 to 60years) ,both male and female were recruited. The yoga group received an intervention Yoga module for COPD that included asanas, loosening practices, breathing practices, pranayama, meditation, yogic counseling and lectures 45 min/day, 3days/weeks on alternate days for 12 weeks. Primary and secondary outcomes: Measurements of dyspnea and fatigue on the spirometry, exercise capacity by the 6 min walk test, COPD QUESSIONAIRE, and C –Reactive protein (CRP) for inflammatory response were made before and after the intervention.Results: Statistically significant within group reductions in dyspnea (P <0.001), COPD quessionaire (P <0.001) scores, CRP (P <0.001), and 6 min walk distance (P <0.001) were observed in the yoga group; all except the last were significant compared to controls (P <0.001). Conclusions: Findings indicate that yoga benefits patients with COPD. Yoga can now be included as an adjunct to conventional therapy for pulmonary rehabilitation to most cases of COPD can be prevented by Yoga programs for COPD patients.

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Abstract This analysis extrapolates information from previous studies and experiences to bring physical medicine and rehabilitation perspective and intervention to the multidisciplinary treatment of COVID-19. The purpose of pulmonary rehabilitation in COVID-19 patients is to improve symptoms of dyspnea, relieve anxiety, reduce complications, minimize disability, preserve function, and improve quality of life. Pulmonary rehabilitation during the acute management of COVID-19 should be considered when possible and safe and may include nutrition, airway, posture, clearance technique, oxygen supplementation, breathing exercises, stretching, manual therapy, and physical activity. Given the possibility of long-term disability, outpatient posthospitalization pulmonary rehabilitation may be considered in all patients hospitalized with COVID-19.

Introduction: COPD or chronic obstructive pulmonary disease is a chronic ongoing progressive disease of the lower respiratory tract in the lungs. COPD result of increasing airway resistance secondary to bronchial mucosal edema or smooth muscle contraction. It affects the movements of air in and out of lungs. Pulmonary Rehabilitation is an exercise and education program that can greatly benefit those with lung disease such as asthma, emphysema and chronic bronchitis. Methodology: Present study aims to assess the effectiveness of structured teaching programme on knowledge regarding COPD and pulmonary rehabilitation among COPD patients in selected hospitals of District Hoshiarpur, Punjab. Quantitative approach with pre-experimental study was adopted to achieve objectives in this study. A sample of 60 COPD patients was selected using consecutive sampling technique. Structured knowledge was used to collect the data. Pre-test data was collected and structured teaching programme was administered to COPD patients and posttest data was collected. The data was analyzed using descriptive and inferential statistics. Results: Results of study showed that mean pretest knowledge score was 13.0±3.974 lower than the mean posttest knowledge score 22.2±1.941 with mean difference of 9.2 and paired t value (t=18.23 and p=0.001) was highly significant at p<0.05. Findings indicated that structured teaching programme was effective in improving the knowledge regarding COPD and pulmonary rehabilitation among COPD patients. Conclusion: The findings of the study concluded that patients were having average knowledge regarding and structured teaching programme was effective in improving the knowledge regarding COPD and pulmonary rehabilitation among chronic obstructive pulmonary disease patients. Study findings suggests that educational programmes can be implemented to enhance their knowledge which can help them to prevent from complications of COPD and maintain the functional activity of the lungs among COPD patients.

Background and aim The long-term effects of pulmonary rehabilitation (PR) and maintenance programs in obstructive pulmonary diseases have not been sufficiently investigated, particularly in diseases other than COPD. This retrospective study aimed to examine the long-term results of individualized comprehensive outpatient pulmonary rehabilitation in patients with obstructive pulmonary disease. Materials and methods This study is a single-center, retrospective cohort study. Between 2010 and 2019, 269 patients with chronic airway obstruction were treated in our multidisciplinary PR center at a tertiary training and research hospital, and they were divided into three groups based on their diagnosis: COPD, bronchiectasis, and asthma. Patients’ perceptions of dyspnea, exercise capacity, inspiratory and peripheral muscle strength, body composition, quality of life, and psychosocial status were compared at the beginning, end, and 12th and 24th months of PR. Results Improvements in dyspnea perception remained longer in asthmatics than in the other two groups. The increases in exercise capacity in the bronchiectasis and asthma groups lasted two years. All groups maintained their respiratory muscle strength gains at the end of the second year. Improvements in hand grip strength in the COPD and bronchiectasis groups have been sustained for two years, but in the asthma group, enhancements were lost in the second year. Even after the second year, quality of life was still better than the baseline in all groups, despite a worsening in the first year. However, groups anxiety and depression improvements were not sustained after the first year. Conclusion The long-term effectiveness of PR in patients with bronchiectasis and asthma was similar to that of COPD patients. Therefore, multidisciplinary, comprehensive PR programs should be integrated into the management of patients with bronchiectasis and asthma. We also recommend structured follow-up programs to maintain gains and to detect the need for rerehabilitation.

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Objective: To evaluate the effectiveness of continuous nursing interventions in elderly patients with COPD in the stable phase and frailty. Methods: Sixty elderly patients with COPD in the stable phase and frailty, treated between January 2024 and August 2024, were selected as the study subjects. Patients were randomly divided into two groups (30 each) using a drawing method. Patients who drew a black token were assigned to the intervention group and received continuous nursing interventions, while those who drew a red token were assigned to the nursing group and received standard nursing care. The quality of care between the groups was compared. Results: Pulmonary function indicators in the intervention group were significantly better than those in the nursing group (P < 0.05). Immune function in the intervention group was also significantly higher than in the nursing group (P < 0.05). Before the intervention, there was no significant difference in self-care ability between the two groups (P > 0.05). However, post-intervention, both groups showed improved self-care abilities, with the intervention group scoring significantly higher than the nursing group (P < 0.05). Similarly, before the intervention, there was no significant difference in quality-of-life scores (P > 0.05), but post-intervention, both groups exhibited increased scores, with the intervention group outperforming the nursing group significantly (P < 0.05). Conclusion: Continuous nursing interventions significantly improve outcomes in elderly patients with COPD in the stable phase and frailty, warranting broader implementation.

Objectives Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) patients experience a lower quality of life, frequent exacerbations, and worse pulmonary function. Environmental management is essential in a complex chronic condition, as pollutant exposure can worsen symptoms and increase morbidity and mortality. We aimed to identify evidence that informs nursing interventions in promoting self-management of air quality in asthmatic people with COPD. Methods We conducted an integrative review in March of 2023. We searched the databases CINAHL, MEDLINE, Academic Search Complete, Cochrane Database of Systematic Reviews (CDSR), Scopus, Web of Science, Joanna Briggs Institute (JBI) Evidence-Based Practice Database, and Google Scholar. We included articles whose participants were adults with asthma, COPD, or both; the intervention was air quality management and the outcome of any exacerbations. We excluded editorials, letters, commentaries, opinion papers, position papers, study protocols, conference abstracts, and reviews. Data extraction and synthesis were performed, categorizing interventions according to nursing actions. Methodological quality assessment was conducted using the JBI Critical Appraisal Checklist tools. The review protocol was registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/5Y4KW). Results We included five articles from different countries. The interventions promoting air quality self-management for individuals with asthma and COPD included vigilance interventions (health professional regular visits, assessment of symptoms), monitoring interventions (measurement of indoor and outdoor trigger factors), and educational interventions (air quality alerts, allergen avoidance). Policy interventions such as smoke-free policies and comprehensive strategies to improve air quality were also identified. These areas of focus represent critical components of nurses’ interventions and can integrate the fundamental patterns of knowing in nursing. Although the studies reveal heterogeneous interventions and the methodological quality is variable, these interventions showed potential for preventing exacerbations, reducing emergency department visits, and minimizing hospitalizations. Conclusions The study emphasizes the need for a comprehensive approach involving nurses in multidisciplinary teams to air quality self-management. They can use these results to inform their interventions and ways of knowing, benefiting individuals with asthma and COPD. Further research is needed to expand the evidence base and refine these interventions.

Objective We analyzed the characteristics and risk factors for pulmonary infection in patients with spinal cord injury who underwent tracheostomy and propose measures to help in early detection and intervention to reduce mortality and improve prognosis. Methods We collected data retrospectively from January 1, 2018, to December 31, 2022. The inclusion criteria were: Patients aged 18 years or more with a spinal cord injury who underwent tracheostomy, were treated with mechanical ventilation for over 48 hours, and were diagnosed as having a pulmonary infection. Sputum samples were cultured and analyzed. Results 101 cases of pulmonary infection were analyzed, and the incidence was 32.17%. Diabetes (OR 2.302, 95% CI 1.285–3.972), hypoproteinemia (OR 1.992, 95% CI 1.125–3.101), administration of glucocorticoids (OR 2.934, 95% CI 1.412–4.661), ASIA grade A (OR 3.672, 95% CI 1.988–5.046), mechanical ventilation for ≥ 6 days (OR 2.108, 95% CI 1.385–4.751), and length of hospital stay for ≥ 20 days (OR 2.137, 95% CI 1.092–3.842) were risk factors for pulmonary infection in patients with spinal cord injury post-tracheostomy. Among 213 pathogenic bacteria, 52 (51.48%) were Gram-negative and 24 (23.76%) were Gram-positive. Klebsiella pneumoniae (15.84%) and Staphylococcus aureus (8.91%) were the most common pathogenic bacteria. The mortality rate of patients with gram-positive infection was higher than that of patients with gram-negative infection. K. pneumoniae and S. aureus were sensitive to cefoperazone, meropenem, and levofloxacin. Conclusion Pulmonary infection is a complication post-tracheostomy in patients with spinal cord injury. Diabetes, hypoproteinemia, administration of glucocorticoids, mechanical ventilation for ≥ 6 days, length of hospital stay for ≥ 20 days were risk factors for pulmonary infection. Pulmonary infection was mainly caused by gram-negative bacteria. Timely and effective measures for managing risk factors are essential for improving the prognosis of pulmonary infection post-tracheostomy in patients with spinal cord injuries.

BackgroundThe increasing prevalence and associated cost of treating Chronic Obstructive Pulmonary Disease (COPD) is unsustainable, and focus is needed on self-management and prevention of hospital admissions. Telehealth monitoring of patients’ vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health. This paper reports the results of a qualitative study embedded within a feasibility and pilot Randomised Controlled Trial (RCT) of Telehealth-supported care within a community-based COPD supported-discharge service. The aim of the study was to qualitatively explore the experiences of patients with COPD who had received either a Telehealth-supported or a specialist nursing intervention following their discharge from hospital after an admission for a COPD exacerbation.MethodsPatients were invited to either participate in semi-structured interviews or to complete a semi-structured self-administered questionnaire on completion of the intervention. Nine patients were interviewed (67 % female) and seventeen patients completed the questionnaires. In addition, three clinicians responsible for the delivery of both interventions were interviewed to obtain their perspectives on the new services.ResultsSeven underlying themes emerged from the patient interviews and were further explored in the questionnaires: (1) patient demographics; (2) information received by the participants; (3) installation of the Telehealth technology; (4) Telehealth service functionality; (5) visits; (6) service withdrawal; and (7) service perceptions. Recipients of both services reported feelings of safety derived from the delivery of an integrated, community-based service.ConclusionsAlthough recipients of the Telehealth service received 50 % fewer home visits from the clinicians than recipients of a more traditional community-based nursing intervention, the patients were enthusiastic about the service, with some describing it as the best service they had ever received. This suggests that a Telehealth intervention is an acceptable alternative to a more traditional home nursing visit model for monitoring community-based patients with COPD following their discharge from hospital.Trial registrationCurrent Controlled Trials ISRCTN68856013

BACKGROUND Healthcare-associated infections remain a major patient safety threat, yet prevention efforts to date mainly focus on device-associated infections, neglecting the burden of non-device-associated HAIs (NDA-HAIs). Nursing care interventions are considered to impact NDA-HAI prevention, yet evidence on their effect remains uncertain. This research examines the evidence linking fundamental nursing care interventions to the prevention of NDA HAI to better understand the role of nursing practice in preventing NDA-HAI. METHODS A scoping review was conducted, following Joanna Briggs Institute methodology, exploring evidence linking fundamental nursing care interventions to prevention of NDA-HAIs. Eligible studies involved adult patients in inpatient settings, NDA-HAIs and related nursing care components. RESULTS 159 studies were identified within this review. Findings revealed limited high-quality evidence on nursing care interventions and NDA-HAIs. The highest proportion of studies focused on the prevention of healthcare associated pneumonia with limited evidence on the role of nutrition and gastrointestinal diseases. Oral care was the most evidenced intervention in quantity of evidence available. Hydration had the most evidence across all NDA-HAI assessed. The combined impact of fundamental nursing care interventions on NDA-HAI was limited. This suggests a need for more focused research on the effect of nursing care interventions in the prevention of NDA-HAI. CONCLUSION Nursing care interventions may play a key role in IPC, however there is a need for an improved evidence base for practice, particularly in preventing NDA-HAI.

Background: The rapidly increasing number of Coronavirus Disease 2019 (COVID-19) cases worldwide has led to higher hospital densities and increased the workload of nurses. Aim: This retrospective and descriptive study was planned to determine COVID-19-related nursing diagnoses, interventions, and outcomes in hospitalized patients with COVID-19. Methods: The study was conducted using the records of individuals (n = 849) who were hospitalized at a university hospital with a diagnosis of COVID-19 between March 2020 and February 2021. Data were collected using a form developed by the researchers, based on North American Nursing Diagnosis Association International (NANDA-I) nursing diagnoses, Nursing Interventions Classification (NIC) nursing interventions, and Nursing Outcomes Classification (NOC) nursing outcomes. Descriptive statistics were used to analyze the data. Results: The most frequently used nursing diagnoses during hospitalization were identified as “Risk for injury,” “Risk for infection,” “Risk for transmission of infection,” “Ineffective breathing pattern,” and “Risk for impaired skin integrity.” The most frequently used interventions specific to these diagnoses included: “Introduce environmental measures during each hospitalization,” “Monitor vital signs regularly,” “Implement isolation methods based on the infectious agent,” “Auscultate lung sounds,” and “Provide oxygen support.” The “Reached” outcome was marked for all patients except those who died during the evaluation. Conclusion: It is recommended to plan in-service training for nurses to enhance the effective use of NANDA-I diagnosis, NIC interventions, and NOC outcomes. Additionally, integrating up-to-date guidelines into the electronic information systems used in healthcare institutions is suggested.

Purpose Coronavirus disease 2019 (COVID-19) impacted outcomes of persons with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). This study investigated the differences in respiratory interventions, hospital utilization, smoking status, and 30-day readmission in those with COPD and COVID-19 based on hospital survival status. Methods A retrospective cross-sectional study was conducted from February 2020 to October 2020 and included persons with COPD and COVID-19 infection. We examined respiratory interventions, hospital utilization and outcomes, and 30-day hospital readmission. Chi-square test analysis was used to assess categorical variables, and t-test or Mann–Whitney was used to analyze continuous data based on normality. Results Ninety persons were included in the study, 78 (87%) were survivors. The most common comorbidity was hypertension 71 (78.9%) (p = 0.003). Twenty-two (24%) persons were intubated, from whom 12 (15%) survived (p < 0.001). There were 25 (32.1%) and 12 (100%), (p < 0.001) persons who required an ICU admission from the survivor and non-survivor groups, respectively. Among the survivor group, fifteen (19%) persons required 30-day hospital readmission. Conclusion Persons with COPD and COVID-19 had a lower mortality rate (13%) compared to other studies in the early pandemic phase. Non-survivors had increased ICU utilization, endotracheal intubation, and more frequent application of volume control mode. Discharging survivors to long-term acute care facilities may reduce 30-day hospital readmissions.

Objective: To observe the rehabilitation effect of cardiothoracic surgery patients after the implementation of comprehensive nursing intervention. Methods: Eighty patients who underwent cardiothoracic surgery in a hospital from April 2023 to March 2024 were selected and divided into the control group (n=40) and the observation group (n=40) according to the method of randomized numerical table, with the control group adopting conventional nursing interventions and the observation group implementing comprehensive nursing interventions. Comparison of respiratory function, complication rate, and quality of life (QOL) score indexes in the two groups. Results: Comparing the respiratory function of the two groups, the ratio of the 1st second exertion respiratory volume to the exertion lung capacity of the patients in the observation group (0.57 ± 0.01)%,     Exertion respiratory volume at 1st second (1.45 ± 0.04)L,         (2.54 ± 0.31)L, and partial pressure of oxygen (94.03 ± 5.17)mmHg were higher than those of the control group (0.41 ± 0.02)%, (90.12 ± 5.28)L, (2.29 ± 0.28)L, and (94.03 ± 5.17)mmHg, and partial pressure of carbon dioxide of the observation group patients (36.55 ± 3.15)mmHg was lower than that of the control group (41.47 ± 3.23) mmHg. The difference was statistically significant (P < 0.05); 1 case of lower limb deep vein thrombosis occurred in the observation group,           lung infection in the observation group, with a total incidence rate of 5.00%, and 1 case of incision infection in the control group. In the control group, there were 2 cases of postoperative bleeding, 3 cases of cardiac arrhythmia, 3 cases of lower limb deep vein thrombosis, and 1 case of pulmonary infection, with a total incidence rate of 22.50%, and the difference between the groups was statistically significant (P < 0.05); the scores of social function, physical function, emotional function, physical function, mental health, general health, vitality, and physical pain in each dimension of the patients in the observation group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). Conclusion: The implementation of comprehensive nursing interventions for cardiothoracic surgery patients can effectively improve patients’ pulmonary function indexes, reduce the risk of related complications, and improve patients’ quality of life, which is worth promoting.

Objective: To explore the effects of respiratory exercise rehabilitation nursing on self-care ability, lung function, and quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods: A total of 88 patients with COPD admitted from February 2024 to February 2025 were selected and randomly divided into an experimental group and a control group, with 44 patients in each group. The control group received routine nursing, while the experimental group received respiratory exercise rehabilitation nursing on the basis of routine nursing. After 12 weeks of intervention, the self-care ability, lung function, and quality of life of the two groups were compared. Results: After the intervention, the scores of each dimension and the total score of self-care ability in the experimental group were significantly higher than those in the control group (p < 0.001). The improvement of lung function indicators such as FEV₁, FVC, and FEV₁/FVC in the experimental group was better than that in the control group (p < 0.001). The scores of each dimension and the total score of quality of life in the experimental group were significantly lower than those in the control group (p < 0.001). Conclusion: Respiratory exercise rehabilitation nursing can effectively improve the self-care ability, lung function, and quality of life of patients with COPD, which is worthy of clinical promotion and application.

Objective: to study the effect of continuous nursing intervention in patients with chronic obstructive pulmonary disease (COPD). Methods: In this paper, 56 COPD patients were selected and grouped by drawing lots, with 28 cases in each group. The study group underwent continuous nursing intervention, while the control group underwent conventional care, and the parameters of both groups of patients were compared. Results: Compared with the control group, the patients in the study group had a significantly higher forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC), a significantly lower COPD Assessment Test (CAT) score, and Hamilton Depression (HAM-D) score, and a significantly higher 6-Minute Walk Test (6WMT) score after nursing care. Besides, their self-care ability score and SaO2 were significantly higher, while their PaCO2 and coagulation indexes were significantly lower (P < 0.05). Conclusion:Continuous nursing intervention is beneficial for COPD patients.

People living with chronic obstructive pulmonary disease (COPD) are a group who may be particularly vulnerable to COVID-19. This vulnerability has been associated with increased anxiety or fear about exposure to the virus, which may also impact upon experience in healthcare settings. The aim of this narrative mixed-methods review was to systematically scope, identify and synthesise findings from peer-reviewed qualitative, quantitative and mixed-methods studies published in academic journals describing the healthcare experiences of adults living with COPD independently in the community, following the emergence of COVID-19 in December 2019-June 2022. Databases including Ovid MEDLINE, PsychINFO, Ovid Emcare and CINAHL Plus were searched. Studies were uploaded to Covidence to support selection and appraisal of studies. Studies were appraised for quality using the Mixed Methods Appraisal Tool. A narrative synthesis of these themes was provided, and qualitative and quantitative findings are interpreted together in the discussion. The quality and experience of care for patients with COPD was impacted through the COVID-19 pandemic. Innovations and adoption of technologies such as telehealth and telerehabilitation were well received and mitigated the potential implications of severe disruption to care access to some extent. Patients feared feeling forgotten and experienced isolation and anxiety; however, telerehabilitation and exercise through modalities such as Zoom classes help support social connection and physical activity. These innovations are likely to be useful to be offered to patients on an ongoing basis, and education and standardised protocols around their use will benefit healthcare providers and patients alike. CRD42022341168.

Chronic respiratory failure is defined on the basis of gas exchange in the lung. Recent studies have suggested serious clinical problems in patients with disabling dyspnea not necessarily related to gas exchange. Home oxygen therapy not only prolongs life expectancy but also improves the quality of daily life. In Japan, pulmonary emphysema, sequelae of pulmonary tuberculosis, and interstitial pneumonia/pulmonary fibrosis are the 3 major diseases currently treated by home oxygen therapy. Respiratory failure caused by interstitial pneumonia/pulmonary fibrosis and lung cancer is on the increase and is also treated by home oxygen therapy. Clinical problems on mechanisms and treatment of chronic respiratory failure are reviewed from recent data.

Lung volume reduction surgery (LVRS) is an experimental surgical procedure that aims to alleviate the symptoms of breathlessness for patients with end-stage chronic emphysema. Emphysema (from the Greek for 'puff up') is a progressive chronic obstructive pulmonary disease (COPD) and risk factors include smoking and chronic infections. The disease causes the alveoli of the lung to over-expand and lose their elasticity (Schedel and Connolly, 1999). Advanced emphysema causes severe dyspnoea that significantly reduces the patient's quality of life.

No abstract

This report describes an extremely rare case of combined penetrating trauma that includes the head, neck, chest, abdomen and scrotum. A 46-year-old male construction worker fell from a 5-metre-high platform, and a rebar that was fixed vertically on the ground penetrated the scrotum into the pelvic and abdominal cavities, passing through the chest, neck, mouth, and nose to the outside of the body through the left side of the head. The rebar penetrated the oral cavity and was palpable on the anterior side of the neck and abdomen. The head, neck, chest and abdominal CT scan and reconstruction showed brain contusion, fractures of the skull and skull base, subarachnoid haemorrhage, palate injury, tongue injury, injury to the right lobe of the thyroid, pleural effusion, pulmonary contusion, cardiac contusion, injury to the left lobe of the lung, neck and mediastinal emphysema, and pneumothorax. Emergency green channels provide a rescue process for urgent and severe cases and smooth and timely diagnostic and treatment process to save patients' lives. The medical staff worked together as a team for the initial evaluation and rescue. Emergency nurses played an important role in communicating, cooperating, managing insulation and pain, and providing psychological counselling, which greatly enhanced the efficiency and quality of the nursing. After the patient underwent surgery, anti-infection treatment, sedatives, analgesics, nutritional therapy, psychological support, and other intensive treatment measures, he recovered well two months after the injury. Follow-up at 5 and 11 months after discharge showed good recovery.

Chronic obstructive pulmonary disease (COPD) is the fifth leading cause of mortality in the United States. Most clients are initially seen when symptomatic and significant lung damage has already occurred; most cases are preventable. There is no cure for COPD, but lifestyle changes (especially smoking cessation) and proper treatment can significantly impact quality of life. The diagnostic tools most commonly used include chest x-ray, arterial blood gases, and pulmonary function tests. Pharmacologic interventions include steroids, bronchodilators, mucolytics, and an armamentarium of antibiotics, which must be selected with careful discretion. Because the prognosis of COPD may be guarded, the practitioner is obligated to provide information on advance directives. A sensitive approach, holistic perspective, consistent follow-up, and clinical astuteness are essential ingredients in the management of clients with COPD.

Chronic obstructive pulmonary disease (COPD) is a major cause of years of life lost globally. Acute exacerbations of COPD (AECOPD) drive disease progression, reduce quality of life and are a source of mortality in COPD. Approximately 50% of AECOPD are due to bacterial infections. Diagnosing bacterial infection as the aetiology of AECOPD however remains challenging as investigations are limited by practicality, accuracy and expense. Clinicians have traditionally used sputum colour as a marker of bacterial infection in AECOPD, despite the lack of high-quality evidence for this practice. The aim of this systematic review and meta-analysis is to determine the diagnostic accuracy of sputum colour in the diagnosis of bacterial causes of AECOPD. Articles will be searched for in electronic databases (MEDLINE, Google Scholar Scopus, Web of Science, Africa-Wide, CINAHL and Health Source Nursing Academy) and we will conduct a review of citation indexes and the grey literature. Two reviewers will independently conduct study selection, against pre-defined eligibility criteria, data extraction and quality assessment of included articles using the QUADAS-2 tool. We will perform a meta-analysis using a bivariate logistic regression model with random effects. We will explore heterogeneity through the visual examination of the forest plots of sensitivities and specificities and through the inclusion of possible sources of heterogeneity as covariates in a meta-regression model if sufficient studies are included in the analysis. We also perform a sensitivity analysis to explore the effect of study quality on our findings. The results of this review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement and will be submitted for peer-review and publication. The findings of this review will assist clinicians in diagnosing the aetiology of AECOPD and may have important implications for decision making in resource-limited settings, as well as for antimicrobial stewardship. PROSPERO CRD42019141498.

Multifarious chronic obstructive pulmonary disease (COPD) guidelines have been published by local, national and global respiratory societies. These guidelines subsume holistic evidence based on recommendations to diagnose, treat, prevent and manage acute exacerbation with COPD. Despite the existing comprehensive recommendations, readmission rates and hospitalisations have increased in the last decade. Evidence to date has reported suboptimal clinical guidelines concordance. Acute exacerbations of COPD (AECOPD) is a common hospital presentation due to varied causes such as infective exacerbations, worsening disease condition, medication non-adherence, lack of education and incomprehensive discharge planning. AECOPD directly and indirectly causes economic burden, disrupts health-related quality of life (HRQol), hasten lung function decline and increases overall morbidity and mortality. COPD being a multimodal chronic disease, consistent interdisciplinary interventions from the time of admission to discharge may reduce readmissions and enhance HRQol among these patients and their families. This protocol adheres to the Joanna Briggs Institute methodology for mixed methods systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. Qualitative, quantitative and mixed methods studies will append this study to explore determinants of COPD guidelines concordance. Comprehensive three-tier search strategies will be used to search nine databases (COCHRANE, EBSCO HOST, MEDLINE, SCIENCE DIRECT, JBI, SCOPUS, WEB OF SCIENCE, WILEY and DARE) in May 2020. Two independent reviewers will screen abstracts and full-text articles in consonance with inclusion criteria. The convergent integrative method narrative review will contribute a deeper understanding of any discrepancies found in the existing evidence. Quality of the studies will be reported and Theoretical Domains Framework (TDF) will be used as a priori to synthesis data. Identified barriers, facilitators and corresponding clinical behavioural change solutions will be categorised using TDF indicators to provide future research and implementation recommendations. Ethical approval is not required and results dissemination will occur through peer-reviewed publication.

The Spanish chronic obstructive pulmonary disease (COPD) guideline phenotypes patients according to the exacerbation frequency and COPD subtypes. In this study, we compared the patients' health-related quality of life (HRQoL) according to their COPD phenotypes. This was a cross-sectional study of COPD patients who attended the outpatient clinic of the Serian Divisional Hospital and Bau District Hospital from 23th January 2018 to 22th January 2019. The HRQoL was assessed using modified Medical Research Council (mMRC), COPD Assessment Test (CAT), and St George's Respiratory Questionnaire for COPD (SGRQ-c). Of 185 patients, 108 (58.4%) were non-exacerbators (NON-AE), 51 (27.6%) were frequent exacerbators (AE), and the remaining 26 (14.1%) had asthma-COPD overlap (ACO). Of AE patients, 42 (82.4%) had chronic bronchitis and only 9 (17.6%) had emphysema. Of the 185 COPD patients, 65.9% had exposure to biomass fuel and 69.1% were ex- or current smokers. The scores of mMRC, CAT, and SGRQ-c were significantly different between COPD phenotypes (p <  0.001). There were significantly more patients with mMRC 2-4 among AE (68.6%) (p <  0.001), compared to those with ACO (38.5%) and NON-AE (16.7%). AE patients had significantly higher total CAT (p = 0.003; p <  0.001) and SGRQ-c (both p <  0.001) scores than those with ACO and NON-AE. Patients with ACO had significantly higher total CAT and SGRQ-c (both p <  0.001) scores than those with NON-AE. AE patients had significantly higher score in each item of CAT and component of SGRQ-c compared to those with NON-AE (all p <  0.001), and ACO [(p = 0.003-0.016; p = < 0.001-0.005) except CAT 1, 2 and 7. ACO patients had significantly higher score in each item of CAT and component of SGRQ-c (p = < 0.001-0.040; p <  0.001) except CAT 2 and activity components of SGRQ-c. The HRQoL of COPD patients was significantly different across different COPD phenotypes. HRQoL was worst in AE, followed by ACO and NON-AE. This study supports phenotyping COPD patients based on their exacerbation frequency and COPD subtypes. The treatment of COPD should be personalised according to these two factors.

No abstract

To determine whether perceived uncertainty and physical symptoms were related to negative mood in hospitalized patients with chronic bronchitis and/or emphysema. Descriptive correlational. Five large teaching hospitals in a city in central Canada. The sample consisted of 15 men and 11 women ranging in age from 53 to 86 years. Mishel Uncertainty in Illness Scale; Somatic Scale of the Bronchitis Emphysema Symptom Checklist; and Tension, Depression and Anger Subscales of the Profile of Mood States. Only the variable of physical symptoms contributed to the negative mood of the subjects with chronic obstructive pulmonary disease, explaining 21% of the variance (p < 0.02). Of the four symptom categories measured (fatigue, dyspnea, congestion, and peripheral-sensory disturbance), only fatigue was a significant predictor (p < 0.006) of negative mood, accounting for 28% of the variance. Negative mood is evidence of impaired coping. The finding that fatigue contributed to negative mood provides support for the theoretic prediction that low energy interferes with an individual's ability to cope with a stressful situation.

A residual postive pressure (R.P.P.) of low magnitude (1 to 4 cm of water) was used during assisted ventilation by pressure relaxator in an attempt to decrease the expiratory dynamic compression of the airways. A ventilatory test involving 80 respiratory insufficient patients (73 men and 7 women) shows that with assistance the tidal volume of half of the subjects increased by more than 20% (average gain: 32%). The patients with the highest RV/TC ratio benefitted most from the method. Finally, the arterial blood gases were not significantly modified. A longitudinal study involving 46 subjects observed for an average period of 24 months revealed a marked subjective improvement in the patients' condition without significant modification of the blood gas figures. No incident or accident was attributed to the use of R.P.P.

In exacerbation of chronic obstructive pulmonary disease (ECOPD) requiring hospitalisation greater access to respiratory specialists improves outcome, but is not consistently delivered. The UK National Confidential Enquiry into Patient Outcome and Death 2015 enquiry showed over 25% of patients receiving acute non-invasive ventilation (NIV) for ECOPD died in hospital. On 16 June 2015 the Northumbria Specialist Emergency Care Hospital (NSECH) opened, introducing 24/7 specialty consultant on-call, direct admission from the emergency department to specialty wards and 7-day consultant review. A Respiratory Support Unit opened for patients requiring NIV. Before NSECH the NIV service included mandated training and competency assessment, 24/7 single point of access, initiation of ventilation in the emergency department, a door-to-mask time target, early titration of ventilation pressures and structured weaning. Pneumonia or hypercapnic coma complicating ECOPD have never been considered contraindications to NIV. After NSECH staff-patient ratios increased, the NIV pathway was streamlined and structured daily multidisciplinary review introduced. We compared our outcomes with historical and national data. Patients hospitalised with ECOPD between 1 January 2013 and 31 December 2016 were identified from coding, with ventilation status and radiological consolidation confirmed from records. Age, gender, admission from nursing home, consolidation, revised Charlson Index, key comorbidities, length of stay, and inpatient and 30-day mortality were captured. Outcomes pre-NSECH and post-NSECH opening were compared and independent predictors of survival identified via logistic regression. There were 6291 cases. 24/7 specialist emergency care was a strong independent predictor of lower mortality. Length of stay reduced by 1  day, but 90-day readmission rose in both ventilated and non-ventilated patients. Provision of 24/7 respiratory specialist emergency care improved ECOPD survival and shortened length of stay for both non-ventilated and ventilated patients. The potential implications in respect to service design and provision nationally are substantial and challenging.

Patients with chronic obstructive pulmonary disease (COPD) have varying degrees of compromised airway function that can affect their ability to tolerate dental treatment. Thus, the delivery of dental care to individuals with COPD may need to be modified based on an understanding of the severity and control of the patient's disease, exacerbating factors, frequency of signs/symptoms, and disease management protocols. There is a strong association between aspiration of plaque organisms and pneumonia in individuals with COPD. Good oral hygiene and tobacco cessation education can help mitigate COPD exacerbations.

No abstract

Chronic obstructive pulmonary disease (COPD) is prevalent in nursing home residents. National and international guidelines exist for management of COPD; however, little is known about "real-world" management of COPD in this population. Nursing home patients with significant cognitive impairment may have difficulty utilizing handheld device (HHD) formulations of respiratory medications and may be clinically appropriate candidates for nebulized therapy. To determine (a) the prevalence, clinical characteristics, and treatment of patients with a diagnosis of "emphysema/COPD" per Minimum Data Set (MDS) version 2.0 records in U.S. nursing homes and (b) the relationship of nebulized versus HHD formulations of medication to prevalence of shortness of breath in a cohort of cognitively impaired nursing home residents. In a descriptive, retrospective analysis of a large data repository of skilled nursing home residents with COPD, prescription claims and MDS data from October 1, 2009, through September 30, 2010, were extracted, linked, and de-identified. Measures included medications, diagnoses, and selected outcome parameters from the MDS. Cognitive impairment was defined as a score of 3-6 on the Cognitive Performance Scale derived from MDS records. A proxy of ≤ 14-day courses of respiratory antibiotics, oral corticosteroids, or both was used to identify COPD exacerbations. Shortness of breath (SOB) in the last 7 days was captured from Section J1.l. of the MDS. The total number of unique patients with at least 1 MDS record during the study period was 126,121. Of those, 27,106 (21.5%) had COPD. The prevalence rates of diagnoses concurrent with COPD were as follows: asthma = 8.6%, Alzheimer's disease or other dementia = 37.2%, congestive heart failure = 37.5%, anxiety disorder = 23%, depression = 50.1%, pneumonia = 21.2%, and respiratory infection = 9%. 58% of patients with COPD were white females aged 75 years or older. According to the MDS, 62% of COPD patients had a short-term memory problem, while 43.3% of patients had moderately or severely impaired cognitive skills for daily decision making. 83% of COPD patients with pharmacy claims (17,395/27,106) received at least 1 medication used to treat COPD; 9,711 (17.1%) received no respiratory medications. Use of beta-agonists (53.9%), anticholinergic medications (41.2%), long-acting beta-agonist/corticosteroid (LABA/ICS) combinations (28%) in HHD, and nebulized beta-agonist/anticholinergic combinations (26.6%) was prevalent. Inhaled LABA/ICS and long-acting anticholinergic therapy was received by 28% and 22% residents, respectively. 22% (n = 5,085) of patients exhibited at least 2 exacerbations of COPD, and 33% were noted to have SOB. Monotherapy with short-acting beta-agonists (SABA) was evident in 48.7% of cognitively impaired COPD patients. SOB within the previous 7 days was noted in 39.1% of cognitively impaired COPD patients treated with nebulized SABA monotherapy. 38% of these patients exhibited 2 or more COPD exacerbations, and 57.9% were hospitalized at least once during the 12-month period. LABA monotherapy or combined LABA/SABA use represented ≤ 1% of beta-agonist use for unique COPD patients with cognitive impairment. In this retrospective analysis of administrative data, 21.5% of nursing home residents had a diagnosis of COPD, and 17% of these residents received no respiratory medications. These residents had significant cognitive and functional impairment and concurrent diagnoses. 22% of residents experienced at least 2 exacerbations of COPD during the 12 months of study. As many as 60% were not receiving inhaled LABA/ICS or inhaled tiotropium, and 33% exhibited SOB. There is significant use of nebulized SABA monotherapy, which may be contributing to SOB and exacerbations or hospitalizations in nursing home residents with COPD.

The fungal disease caused by invasive fungus Saprochaete capitata is becoming an increasingly popular infection. Fungal pathogens mainly occur in patients with immunocompromised disorders such as hematologic malignancies, acute myeloid leukemia, transplant patients. In this study, we presented a COPD patient infected with S. capitata. At the first check, the patient showed cough, dyspnea, chest pain on both sides. The clinical laboratory test result was characterized with high White blood cell (12.8 G/L), HIV negative. The X ray showed bronchitis and emphysema. Bronchoscopy illustrated bronchial mucositis. CT scanner demonstrated pneumonia with fuzzy nodular lesions and thick interstitial organization in both lungs. The patient was treated with ciprofloxacin 800 mg/day; cefuroxime 2250 mmg/day. However, the fever appeared 2 weeks thereafter. The S. capitata was discovered in the bronchial fluid. The patient was then treated with fluconazole 400 mg/day for 14 days. At the end of treatment, all signs and symptoms of S. capitata infection disappeared and the patient recovered. This case study showed that S. capitata infection can occur in the COPD patients and fluconazole is a pertinent drug for treatment of the infection.

In chronic obstructive pulmonary disease (COPD), exacerbations (ECOPD), characterized by an acute deterioration in respiratory symptoms, are fundamental events impacting negatively upon disease progression, comorbidities, wellbeing and mortality. ECOPD also represent the largest component of the socioeconomic burden of COPD. ECOPDs are currently defined as acute worsening of respiratory symptoms that require additional therapy. Definitions that require worsening of dyspnoea and sputum volume/purulence assume that acute infections, especially respiratory viral infections, and/or exposure to pollutants are the main cause of ECOPD. But other factors may contribute to ECOPD, such as the exacerbation of other respiratory diseases and non-respiratory diseases (e.g., heart failure, thromboembolism). The complexity of worsening dyspnoea has suggested a need to improve the definition of ECOPD using objective measurements such as blood counts and C-reactive protein to improve accuracy of diagnosis and a personalized approach to management. There are three time points when we can intervene to improve outcomes: acutely, to attenuate the length and severity of an established exacerbation; in the aftermath, to prevent early recurrence and readmission, which are common, and in the long-term, establishing preventative measures that reduce the risk of future events. Acute management includes interventions such as corticosteroids or antibiotics and measures to support the respiratory system, including non-invasive ventilation (NIV). Current therapies are broad and better understanding of clinical phenotypes and biomarkers may help to establish a more tailored approach, for example in relation to antibiotic prescription. Other unmet needs include effective treatment for viruses, which commonly cause exacerbations. Preventing early recurrence and readmission to hospital is important and the benefits of interventions such as antibiotics or anti-inflammatories in this period are not established. Domiciliary NIV in those patients who are persistently hypercapnic following discharge and pulmonary rehabilitation can have a positive impact. For long-term prevention, inhaled therapy is key. Dual bronchodilators reduce exacerbation frequency but in patients with continuing exacerbations, triple therapy should be considered, especially if blood eosinophils are elevated. Other options include phosphodiesterase inhibitors and macrolide antibiotics. ECOPD are a key component of the assessment of COPD severity and future outcomes (quality of life, hospitalisations, health care resource utilization, mortality) and are a central component in pharmacological management decisions. Targeted therapies directed towards specific pathways of inflammation are being explored in exacerbation prevention, and this is a promising avenue for future research.

74 year-old-man, former smoker, with chronic obstructive pulmonary disease GOLD grade 4, group D, with emphysema component, treated in a pulmonary rehabilitation program, on oxygen therapy and nocturnal bi-level positive airway pressure (BiPAP) ventilation. During the night he had a traumatic rib fracture (5-11th right ribs) but still he used BiPAP ventilation during the sleep. In the morning after he presented with a diffuse and massive emphysema in the face, thorax and abdominal regions. On physical examination, the patient presented with massive swelling and crepitus on palpation. A chest computed tomography (CT) scan confirmed a diffuse subcutaneous emphysema and revealed a mediastinal emphysema and bilateral small pneumothorax. A fast resolution of the emphysema was of paramount importance as the patient was severely agitated due to his inability to open both eyes, and the need to reintroduce BiPAP ventilation as soon as possible. It was placed a fenestrated subcutaneous catheter on left hemithorax and a subcutaneous ostomy on right hemithorax for comparative purpose. It was also performed a confluent centripetal massage towards drainage orifices, with immediate and substantial improvement of emphysema, especially in left hemithorax, and progressive ocular opening. Further emphysema absorption occurred during hospitalization.

COPD is a chronic pathological condition of the respiratory system characterized by persistent and partially reversible airflow obstruction, to which variably contribute remodeling of bronchi (chronic bronchitis), bronchioles (small airway disease) and lung parenchyma (pulmonary emphysema). COPD can cause important systemic effects and be associated with complications and comorbidities. The diagnosis of COPD is based on the presence of respiratory symptoms and/or a history of exposure to risk factors, and the demonstration of airflow obstruction by spirometry. GARD of WHO has defined COPD "a preventable and treatable disease". The integration among general practitioner, chest physician as well as other specialists, whenever required, assures the best management of the COPD person, when specific targets to be achieved are well defined in a diagnostic and therapeutic route, previously designed and shared with appropriateness. The first-line pharmacologic treatment of COPD is represented by inhaled long-acting bronchodilators. In symptomatic patients, with pre-bronchodilator FEV1 < 60%predicted and ≥ 2 exacerbations/year, ICS may be added to LABA. The use of fixed-dose, single-inhaler combination may improve the adherence to treatment. Long term oxygen therapy (LTOT) is indicated in stable patients, at rest while receiving the best possible treatment, and exhibiting a PaO2 ≤ 55 mmHg (SO2<88%) or PaO2 values between 56 and 59 mmHg (SO2 < 89%) associated with pulmonary arterial hypertension, cor pulmonale, or edema of the lower limbs or hematocrit > 55%. Respiratory rehabilitation is addressed to patients with chronic respiratory disease in all stages of severity who report symptoms and limitation of their daily activity. It must be integrated in an individual patient tailored treatment as it improves dyspnea, exercise performance, and quality of life. Acute exacerbation of COPD is a sudden worsening of usual symptoms in a person with COPD, over and beyond normal daily variability that requires treatment modification. The pharmacologic therapy can be applied at home and includes the administration of drugs used during the stable phase by increasing the dose or modifying the route, and adding, whenever required, drugs as antibiotics or systemic corticosteroids. In case of patients who because of COPD severity and/or of exacerbations do not respond promptly to treatment at home hospital admission should be considered. Patients with "severe or "very severe COPD who experience exacerbations should be carried out in respiratory unit, based on the severity of acute respiratory failure. An integrated system is required in the community in order to ensure adequate treatments also outside acute care hospital settings and rehabilitation centers. This article is being simultaneusly published in Multidisciplinary Respiratory Medicine 2014; 9:25.

The chronic obstructive pulmonary disease (COPD) and the bronchial asthma are widespread diseases. They need long-lasting and sustainable rehabilitation. The goal of this HTA is to describe the present supply and the economic relevance of out-patient pulmonary rehabilitation in conjunction with its social aspects. A further target is to derivate options for actions in the health-care system and possible research necessities. Relevant publications are identified by means of a structured search in 37 database accessed through the German Institute of Medical Documentation and Information (DIMDI). In addition a manual search of identified reference lists has been done. The present report includes German and English literature published from 2004 to 2009. The methodological quality was assessed by two independent researchers according to pre-defined quality criteria of evidence based medicine. Among 860 publications 31 medical studies, four economic studies and 13 ethical studies meet the inclusion criteria. The studies cover rehabilitation programmes in 19 countries. The majority of them has a high level of evidence (1A to 2C). The pulmonary rehabilitation programmes differ by the setting (in-patient, out-patient, in-home, community-based), by the length of intervention (from two weeks to 36 months), by the way and the frequency of intervention and by the duration of the follow-up treatment. Overall out-patient rehabilitation programmes achieve the same positive effects for COPD patients as in-patient programmes do. This is especially true for physical performance and health related quality of life. There are only a few studies dealing with asthma. Therefore, valid statements cannot be given. The results for cost-effectiveness are not distinct enough. Goals of pulmonary rehabilitation like prevention and adequate treatment of acute exacerbations, the minimisation of hospitalisation and the reduction of mortality are attained in out-patient as well as in in-patient pulmonary rehabilitation. Regarding the best frequency of training units per week or the duration and the content of a unit further research is needed. Final results for the ideal length of an in-patient rehabilitation are still missing. None of the studies deals with the analysis of the different treatment forms of a COPD which are frequently defined by an alteration of in-patient and out-patient treatments and participation in sports clubs or self-help groups. There are some other limitations of the studies. The results concerning self-management programmes are not distinct. (Self-) Selection leads to high drop-out rates. Many studies have only small sample sizes. Confounder and long-time effects are seldom researched, relevant economic evaluations do not exist The improvement of health related quality of life is primarily obtained by an improved disease management than by an improvement of a medical parameter. Out-patient pulmonary rehabilitation is as effective as in-patient pulmonary rehabilitation. But there is a critical shortage of out-patient pulmonary rehabilitation supply in Germany. Domains for further research are the evaluation of models for integrated care, the length, frequency and content of training programmes, psychiatric assessments and the cost-effectiveness of out-patient pulmonary rehabilitation. Chronisch obstruktive Lungenerkrankungen (COPD) und Asthma bronchiale gehören zu den großen Volkskrankheiten. Sie bedürfen einer langfristigen bis dauerhaften Rehabilitation. Ziel des HTA-Berichts (HTA = Health Technology Assessment) ist es, die derzeitigen Angebote sowie die gesundheitsökonomische Relevanz im Zusammenhang mit der sozialen Komponente der pneumologischen Rehabilitation (PR) darzustellen, Handlungsoptionen für die Akteure im System abzuleiten sowie Forschungsbedarf aufzuzeigen. Relevante Publikationen werden über eine strukturierte Datenbankrecherche in 37 Datenbanken sowie mittels Handrecherche identifiziert. Die Literaturrecherche erstreckt sich von 2004 bis 2009. Die methodische Qualität wird jeweils von zwei unabhängigen Gutachtern unter Beachtung von Kriterien der evidenzbasierten Medizin (EbM) systematisch geprüft. Von insgesamt 860 Treffern erfüllen 31 medizinische, vier ökonomische und 13 ethische Studien die Einschlusskriterien. Die Studien decken Rehabilitationsprogramme in neunzehn Ländern ab. Sie weisen überwiegend einen hohen Evidenzgrad auf (1A bis 2C). Die Modelle der PR unterscheiden sich durch das Setting (in-patient, out-patient, in-home, community-based), durch die Länge der Intervention (zwei Wochen bis 36 Monate), durch die Art und Häufigkeit der Intervention sowie durch die Länge der nachfolgenden Betreuung. Insgesamt zeigt sich, dass sowohl stationäre als auch ambulante PR-Programme positive Wirkungen bei COPD-Patienten erzielen, vor allem können die körperliche Leistungsfähigkeit und die gesundheitsbezogene Lebensqualität gesteigert werden. Die Anzahl der Studien, die sich mit ambulanter Asthmarehabilitation befassen, ist zu gering, um gesicherte Aussagen zu treffen. Die Ergebnisse zur Kosten-Effektivität sind nicht eindeutig. Die Ziele der PR wie die Vorbeugung und adäquate Behandlung akuter Exazerbationen, die Minimierung von Hospitalisationen sowie die Reduktion der Mortalität werden sowohl in stationären als auch in ambulanten Rehabilitationsprogrammen erreicht. Zur optimalen Häufigkeit der Schulungseinheiten pro Woche sowie zur Dauer und zu Schulungsinhalten pro Stunde gibt es weiteren Forschungsbedarf. Auch zur optimalen Länge der ambulanten Rehabilitationsprogramme liegen noch keine abschließenden Ergebnisse vor. Es fehlen Studien, die den realen Ablauf rehabilitativer Maßnahmen bei COPD-Patienten analysieren. Diese rehabilitativen Maßnahmen setzen sich häufig aus einer langfristigen Abfolge von stationären und ambulanten Maßnahmen zusammen. Sie bestehen beispielsweise in der Teilnahme an Sport- und Selbsthilfegruppen. Die Resultate zu Schulungsprogrammen sind nicht eindeutig. (Selbst-)Selektionseffekte führen zu hohen Drop-out-Raten. Viele Studien haben kleine Stichproben, Confounder und Langzeiteffekte werden selten untersucht, relevante ökonomische Evaluationen sind nicht vorhanden. Die Verbesserung der gesundheitsbezogenen Lebensqualität wird primär durch ein verbessertes Krankheitsmanagement und weniger durch eine Verbesserung der medizinischen Parameter erreicht. Die ambulante Rehabilitation kann wie die stationäre Rehabilitation klinisch relevante und signifikante Verbesserungen für die Patienten erbringen. Es besteht jedoch eine deutliche Unterversorgung an ambulanten pneumologischen Rehabilitationsangeboten in Deutschland. Forschungsbedarf gibt es zur Evaluation von Modellen der integrierten Versorgung, zur Dauer, zur Frequenz und zu Inhalten von Trainingsprogrammen, zur psychiatrischen Betreuung und zur Kosten-Effektivität der ambulanten Versorgung.

Conservative management of unilateral tension pulmonary interstitial emphysema is reported. Treatment consisted of (1) positioning the infant on his or her side with the emphysematous lung dependent, (2) minimal chest physiotherapy and endotracheal suctioning, and (3) appropriate ventilator management. Conservative therapy is effective and appears to be safer than selective bronchial intubation or surgical therapy.

No abstract

Chronic obstructive pulmonary disease (COPD) is a common cause of disability and death in Canada. Moreover, morbidity and mortality from COPD continue to rise, and the economic burden is enormous. The main goal of the Canadian Thoracic Society (CTS) Evidence-Based Guidelines is to optimize early diagnosis, prevention and management of COPD in Canada. Targeted spirometry is strongly recommended to expedite early diagnosis in smokers and exsmokers who develop respiratory symptoms, and who are at risk for COPD. Smoking cessation remains the single most effective intervention in accordance with the increasing severity of symptoms and disability. Long-acting anticholinergics and beta2-agonist inhalers should be prescribed for patients who remain symptomatic despite short-acting bronchodilatory therapy. Inhaled steroids should not be used as first-line therapy in COPD but have a role in preventing exacerbations in patients with more advanced disease who suffer recurrent exacerbations. Management strategies consisting of combined modern pharmacotherapy and nonpharmacotherapeutic interventions (eg, pulmonary rehabilitation/exercise training) can effectively improve symptoms, activity levels and quality of life, even in patients with severe COPD. Acute exacerbations of COPD cause significant morbidity and mortality and should be treated promptly with bronchodilators and a short course of oral steroids; antibiotics should be prescribed for purulent exacerbations. Patients with advanced COPD and respiratory failure require a comprehensive management plan that incorporates structured end-of-life care.

Chronic obstructive lung disease affects over 15 million people in the United States. The management of this disease in patients is complex, involving antibiotics, mucolytics, bronchodilators, corticosteroids, and rehabilitation. Several studies investigating controversial areas of management were published in 1993 and 1994. New developments in pulmonary rehabilitation, oxygen therapy, noninvasive ventilation, corticosteroids, bronchodilators, vasodilators for pulmonary hypertension, lung transplantation, lung surgery for bullae, and alpha-1-antitrypsin replacement therapy provide physicians with exciting new opportunities for managing chronic obstructive pulmonary disease.

According to the complexity of pathological change of pulmonary tuberculosis sequelae (TB seq), on which respiratory failure based shows the higher incidence of marked degree of hypoxemia and hypercapnia than that based on chronic pulmonary emphysema (CPE). In TB seq, pulmonary artery mean pressure is higher, nocturnal oxyhemoglobin desaturation is much lower than in CPE. Also hypoxemia on exercise is lower, and oxygen inhalation for this hypoxemia is more effective than in CPE. The most effective therapy is continuous oxygen therapy. Home oxygen therapy has improved the prognosis and quality of life (QOL) of patients with respiratory failure based on TB seq. Artificial positive pressure ventilation (TIPPV) with intubation or tracheotomy is carried out for patients with severe hypercapnia and respiratory acidosis. Recently, early application of nasal mask ventilation (NPPV) on patients with TB seq has prohibited acute exacerbation of chronic respiratory failure. And also for patients with severe hypercapnia, NPPV with BIPAP method is effective for their QOL. Comprehensive respiratory rehabilitation is also successfully applied for their management.

The haphazard method of treating patients seriously ill with emphysema is gradually being replaced by modern, well organized cardiopulmonary therapeutic and rehabilitation programs. This evolution is the result of a further expansion in our knowledge of cardiopulmonary physiology and biochemistry; an additional factor is the recent public awareness of the seriousness of the problem, brought about by public educational programs. Emphysema is chiefly a disease of old age. It develops as a result of a degenerative process in which the alveolar walls become thinner and the lungs less elastic. Senile emphysema per se may not be disabling, but it is often associated with a severe chronic pulmonary disorder and thus can become the most distressing disease of old age, with shortness of breath even on such slight exertion as dressing or talking. Disturbances in cardiopulmonary physiology due to obstruction in the free flow of air and to superimposed infections require the use of all available procedures designed to obtain maximal pulmonary ventilation. The magnitude, the difficulty and the many controversial aspects of this problem are evident. The eventual solution will come gradually with continued interest and research.

The Saudi Thoracic Society (STS) launched the Saudi Initiative for Chronic Airway Diseases (SICAD) to develop a guideline for the diagnosis and management of chronic obstructive pulmonary disease (COPD). This guideline is primarily aimed for internists and general practitioners. Though there is scanty epidemiological data related to COPD, the SICAD panel believes that COPD prevalence is increasing in Saudi Arabia due to increasing prevalence of tobacco smoking among men and women. To overcome the issue of underutilization of spirometry for diagnosing COPD, handheld spirometry is recommended to screen individuals at risk for COPD. A unique feature about this guideline is the simplified practical approach to classify COPD into three classes based on the symptoms as per COPD Assessment Test (CAT) and the risk of exacerbations and hospitalization. Those patients with low risk of exacerbation (<2 in the past year) can be classified as either Class I when they have less symptoms (CAT < 10) or Class II when they have more symptoms (CAT ≥ 10). High-risk COPD patients, as manifested with ≥2 exacerbation or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III. Class I and II patients require bronchodilators for symptom relief, while Class III patients are recommended to use medications that reduce the risks of exacerbations. The guideline recommends screening for co-morbidities and suggests a comprehensive management approach including pulmonary rehabilitation for those with a CAT score ≥10. The article also discusses the diagnosis and management of acute exacerbations in COPD.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, especially among smokers. Many guidelines that have recently been issued emphasize that COPD is not inaccessible to therapeutic measures: although few interventions are capable of affecting its natural history (i.e. smoking cessation and, in patients with severe resting hypoxaemia, oxygen therapy), several others have a demonstrated effect on symptoms and, thereby, quality of life. The effects of inhaled corticosteroids, and alpha 1-antitrypsin replacement therapy in emphysema due to alpha 1-antitrypsin deficiency are currently being studied. When there is a marked increase in mucus production, chest physiotherapy using controlled expiration and directed cough may be useful. Inhaled bronchodilators are frequently effective on dyspnoea, anticholinergic agents being more suitable for continuous symptoms. Rehabilitation, which includes education and psychosocial care, chest physiotherapy, nutritional care and exercise training, also improves quality of life. When there is persistent severe alveolar hypoventilation despite oxygen therapy, long-term mechanical ventilation may be considered. Surgical options in the treatment of emphysema include resection of giant bullae and lung volume reduction surgery. Lung transplantation should be proposed only in patients with end-stage disease, the difficulty here being to define what 'end-stage' means. Finally, all preventive and some therapeutic interventions are likely to be more effective early in the course of the disease. Thus, efforts should be made to detect airways obstruction early in subjects at risk, such as smokers.

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Despite the high prevalence of weight loss in subjects with COPD, the 2011 COPD management guidelines do not include an index measuring nutritional status. Fat-free mass index (FFMI) can accurately determine the nutritional status of subjects and may be closely correlated with COPD severity. We aimed to determine the nutritional status evaluated by FFMI according to the 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) levels in stable subjects with COPD and the association between nutritional status and respiratory symptoms, exercise capacity, and respiratory muscle function. We included 235 stable subjects with COPD in this cross-sectional study. All of the subjects were divided into the 2011 GOLD Groups A, B, C, and D. FFMI (measured by bioelectrical impedance), spirometry (FEV1, percent-of-predicted FEV1, and FEV1/FVC), respiratory muscle function (peak inspiratory and peak expiratory pressures), exercise capacity (6-min walk distance), and dyspnea severity (Modified Medical Research Council dyspnea scale) were measured and compared between the GOLD groups. Malnutrition was identified in 48.5% of subjects and most prevalent in Group D (Group A: 41%, Group B: 41%, Group C: 31%, and Group D: 62%). FFMI was significantly lower in Group D (P < .001), with both sexes considered malnourished. Low FFMI significantly correlated with frequent exacerbation, older age, decreased pulmonary function, 6-min walk distance, peak inspiratory pressure, and worsened dyspnea. FFMI was significantly lower in the emphysema-dominant phenotype and mixed phenotype compared with the normal phenotype and airway-dominant phenotype. A stepwise multiple linear regression analysis identified peak inspiratory pressures and older age as independent predictors of FFMI. Malnutrition is highly prevalent in all COPD groups, particularly in Group D subjects, who warrant special attention for nutritional intervention and pulmonary rehabilitation. FFMI significantly correlated with exercise capacity, dyspnea, respiratory muscle function, and pulmonary function and may be a useful predictor of COPD severity.

Excessive dynamic airway collapse (EDAC) contributes to breathlessness and reduced quality of life in individuals with emphysema. We tested a novel, portable, oral positive expiratory pressure (o-PEP) device in a patient with emphysema and EDAC. MRI revealed expiratory tracheal narrowing to 80 mm

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Amorim, Eduardo Silva O91 Economic impact of a nursing intervention program to promote self-management in COPD Susana Cruz, José M. Padilha, Jorge Valente O92 Multimodal acute pain management during uterine artery embolization in treatment of uterine myomas José T. Guerrero, Francisco P. Caballero, Rafael B. Santos, Estefania P. Gonzalez, Fátima M. Monago, Lierni U. Ugalde, Marta M. Vélez, Maria J. Tena O93 Fluid administration strategies in major surgery: Goal-directed therapy José T. Guerrero, Rafael Bravo, Francisco L. Pérez-Caballero, Isabel A. Becerra, Mª Elizabeth Agudelo, Guadalupe Acedo, Roberto Bajo O94 Development and implementation of a self-management educational programme using lay-led’s in adolescents Spina Bifida: A pilot study Isabel Malheiro, Filomena Gaspar, Luísa Barros O95 Influence of chair-based yoga exercises on salivary anti-microbial proteins in institutionalized frail-elderly women: a preliminary study Guilherme Furtado, Mateus Uba-Chupel, Mariana Marques, Luís Rama, Margarida Braga, José P. Ferreira, Ana Mª Teixeira O96 High intensity interval training vs moderate intensity continuous training impact on diabetes 2 João Cruz, Tiago Barbosa, Ângela Simões, Luís Coelho O97 Family caregiver of people with pressure ulcer: Nursing intervention plan Alexandre Rodrigues, Juan-Fernando Jiménez-Díaz, Francisco Martinez-Hernández, Bienvenida Rodriguez-De-Vera, Pedro Ferreira, Alexandrina Rodrigues O98 Chronic effects of exercise on motor memory consolidation in elderly people André Ramalho, João Petrica, Pedro Mendes, João Serrano, Inês Santo, António Rosado O99 Impression cytology of the ocular surface: Collection technique and sample processing Paula Mendonça, Kátia Freitas O100 Does sport practice affect the reaction time in neuromuscular activity? Dora Ferreira, António Brito, Renato Fernandes O101 Efficiency of the enteral administration of fibbers in the treatment of chronic obstipation Sofia Gomes, Fernando Moreira, Cláudia Pinho, Rita Oliveira, Ana I. Oliveira O102 Fast decalcifier in compact bone and spongy bone Paula Mendonça, Ana P. Casimiro, Patrícia Martins, Iryna Silva O103 Health promotion in the elderly – Intervention project in dementia Diana Evangelista O104 Prevention of musculoskeletal disorders through an exercise protocol held in labour context Catarina Leitão, Fábia Velosa, Nélio Carecho, Luís Coelho O105 Knowledge of teachers and other education agents on diabetes type 1: Effectiveness of an intervention program Eva Menino, Anjos Dixe, Helena Catarino, Fátima Soares, Ester Gama, Clementina Gordo O106 Treatment of diabetic peripheral neuropathic pain: a systematic review of clinical trials of phase II and III Eliana Moreira, Cristiana Midões, Marlene Santos O107 New drugs for osteoporosis treatment: Systematic review of clinical trials of phase II and III Sara Machado, Vânia P. Oliveira, Marlene Santos O108 Promoting hope at the end of life: Effectiveness of an Intervention Programme Ana Querido, Anjos Dixe, Rita Marques, Zaida Charepe P43 Psychomotor therapy effects on adaptive behaviour and motor proficiency of adults with intellectual disability Ana Antunes, Sofia Santos P44 The effect of exercise therapy in multiple sclerosis – a single study case Marlene C. Rosa P45 Physical condition and self-efficacy in people with fall risk – a preliminary study Marlene C. Rosa, Silvana F. Marques P46 Shock waves: their effectiveness in improving the symptoms of calcifying tendinitis of the shoulder Beatriz Minghelli, Eulália Caro P47 Pacifier – construction and pilot application of a parenting intervention for parents of babies until six months in primary health care Mª José Luís, Teresa Brandão P48 The influence of Motor Imagery in fine motor skills of individuals with disabilities Pedro Mendes, Daniel Marinho, João Petrica, Diogo Monteiro, Rui Paulo, João Serrano, Inês Santo P49 Evaluation of the effects of a walking programme on the fall risk factors in older people – a longitudinal pilot study Lina Monteiro, Fátima Ramalho, Rita Santos-Rocha, Sónia Morgado, Teresa Bento P50 Nursing intervention programme in lifestyles of adolescents Gilberta Sousa, Otília Freitas, Isabel Silva, Gregório Freitas, Clementina Morna, Rita Vasconcelos P51 The person submitted to hip replacement rehabilitation, at home Tatiana Azevedo, Salete Soares, Jacinta Pisco P52 Effects of Melatonin use in the treatment of neurovegetative diseases Paulo P. Ferreira, Efrain O. Olszewer, Michelle T. Oliveira, Anderson R. Sousa, Ana S. Maia, Sebastião T. Oliveira P53 Review of Phytotherapy and other natural substances in alcohol abuse and alcoholism Erica Santos, Ana I. Oliveira, Carla Maia, Fernando Moreira, Joana Santos, Maria F. Mendes, Rita F. Oliveira, Cláudia Pinho P54 Dietary programme impact on biochemical markers in diabetics: systematic review Eduarda Barreira, Ana Pereira, Josiana A. Vaz, André Novo P55 Biological approaches to knee osteoarthritis: platelet-rich plasma and hyaluronic acid Luís D. Silva, Bruno Maia, Eduardo Ferreira, Filipa Pires, Renato Andrade, Luís Camarinha P56 Platelet-rich plasma and hyaluronic acid intra-articular injections for the treatment of ankle osteoarthritis Luís D. Silva, Bruno Maia, Eduardo Ferreira, Filipa Pires, Renato Andrade, Luís Camarinha P57 The impact of preventive measures in the incidence of diabetic foot ulcers: a systematic review Ana F. César, Mariana Poço, David Ventura, Raquel Loura, Pedro Gomes, Catarina Gomes, Cláudia Silva, Elsa Melo, João Lindo P58 Dating violence among young adolescents Joana Domingos, Zaida Mendes, Susana Poeta, Tiago Carvalho, Catarina Tomás, Helena Catarino, Mª Anjos Dixe P59 Physical activity and motor memory in pedal dexterity André Ramalho, António Rosado, Pedro Mendes, Rui Paulo, Inês Garcia, João Petrica P60 The effects of whole body vibration on the electromyographic activity of thigh muscles Sandra Rodrigues, Rui Meneses, Carlos Afonso, Luís Faria, Adérito Seixas P61 Mental health promotion in the workplace Marina Cordeiro, Paulo Granjo, José C. Gomes P62 Influence of physical exercise on the self-perception of body image in elderly women: A systematic review of qualitative studies Nelba R. Souza, Guilherme E. Furtado, Saulo V. Rocha, Paula Silva, Joana Carvalho O109 Psychometric properties of the Portuguese version of the Éxamen Geronto-Psychomoteur (P-EGP) Marina Ana Morais, Sofia Santos, Paula Lebre, Ana Antunes O110 Symptoms of depression in the elderly population of Portugal, Spain and Italy António Calha O111 Emotion regulation strategies and psychopathology symptoms: A comparison between adolescents with and without deliberate self-harm Ana Xavier, Marina Cunha, José Pinto-Gouveia O112 Prevalence of physical disability in people with leprosy Liana Alencar, Madalena Cunha, António Madureira O113 Quality of life and self-esteem in type 1 and type 2 diabetes mellitus patients Ilda Cardoso, Ana Galhardo, Fernanda Daniel, Vítor Rodrigues O114 Cross-cultural comparison of gross motor coordination in children from Brazil and Portugal Leonardo Luz, Tatiana Luz, Maurício R. Ramos, Dayse C. Medeiros, Bruno M. Carmo, André Seabra, Cristina Padez, Manuel C. Silva O115 Electrocardiographic differences between African and Caucasian people António Rodrigues, Patrícia Coelho, Alexandre Coelho O116 Factors associated with domestic, sexual and other types of violence in the city of Palhoça - Brazil Madson Caminha, Filipe Matheus, Elenice Mendes, Jony Correia, Marcia Kretzer O117 Tinnitus prevalence study of users of a hospital of public management - Spain Francisco J. Hernandez-Martinez, Juan F. Jimenez-Diaz, Bienvendida C. Rodriguez-De-Vera, Carla Jimenez-Rodriguez, Yadira Armas-Gonzalez O118 Difficulties experienced by parents of children with diabetes mellitus of preschool age in therapeutic and nutritional management Cátia Rodrigues, Rosa Pedroso O119 E-mental health - “nice to have” or “must have”? Exploring the attitudes towards e-mental health in the general population Jennifer Apolinário-Hagen, Viktor Vehreschild O120 Violence against children and adolescents and the role of health professionals: Knowing how to identify and care Milene Veloso, Celina Magalhães, Isabel Cabral, Maira Ferraz O121 Marital violence. A study in the Algarve population Filipe Nave, Emília Costa, Filomena Matos, José Pacheco O122 Clinical factors and adherence to treatment in ischemic heart disease António Dias, Carlos Pereira, João Duarte, Madalena Cunha, Daniel Silva O123 Can religiosity improve optimism in participants in states of illness, when controlling for life satisfaction? Lisete M. Mónico, Valentim R. Alferes, Mª São João Brêda, Carla Carvalho, Pedro M. Parreira O124 Empowerment, knowledge and quality of life of people with diabetes type 2 in the Alto Minho Health Local Unit Mª Carminda Morais, Pedro Ferreira, Rui Pimenta, José Boavida O125 Antihypertensive therapy adherence among hypertensive patients from Bragança county, Portugal Isabel C. Pinto, Tânia Pires, Catarina Silva O126 Subjective perception of sexual achievement - An exploratory study on people with overweight Maria Ribeiro, Maria Viega-Branco, Filomena Pereira, Ana Mª Pereira O127 Physical activity level and associated factors in hypertensive individuals registered in the family health strategy of a basic health unit from the city of Palhoça, Santa Catarina, Brazil Fabrícia M. Almeida, Gustavo L. Estevez, Sandra Ribeiro, Marcia R. Kretzer O128 Perception of functional fitness and health in non-institutionalised elderly from rural areas Paulo V. João, Paulo Nogueira, Sandra Novais, Ana Pereira, Lara Carneiro, Maria Mota O129 Medication adherence in patients with type 2 diabetes mellitus treated at primary health care in Coimbra Rui Cruz, Luiz Santiago, Carlos Fontes-Ribeiro O130 Multivariate association between body mass index and multi-comorbidities in elderly people living in low socio-economic status context Guilherme Furtado, Saulo V. Rocha, André P. Coutinho, João S. Neto, Lélia R. Vasconcelos, Nelba R. Souza, Estélio Dantas O131 Metacognition, rumination and experiential avoidance in Borderline Personality Disorder Alexandra Dinis, Sérgio Carvalho, Paula Castilho, José Pinto-Gouveia O132 Health issues in a vulnerable population: nursing consultation in a public bathhouse in Lisbon Alexandra Sarreira-Santos, Amélia Figueiredo, Lurdes Medeiros-Garcia, Paulo Seabra O133 The perception of quality of life in people with multiple sclerosis accompanied in External Consultation of the Local Health Unit of Alto Minho Rosa Rodrigues, Mª Carminda Morais, Paula O. Fernandes O134 Representation of interaction established between immigrant women and nurse during pregnancy to postpartum, from the perspective of immigrant women Conceição Santiago, Mª Henriqueta Figueiredo, Marta L. Basto O135 Illness perceptions and medication adherence in hypertension Teresa Guimarães, André Coelho, Anabela Graça, Ana M. Silva, Ana R. Fonseca O136 A Portuguese study on adults’ intimate partner violence, interpersonal trust and hope Luz Vale-Dias, Bárbara Minas, Graciete Franco-Borges P63 QOL’ predictors of people with intellectual disability and general population Cristina Simões, Sofia Santos P64 Content validation of the Communication Disability Profile (CDP) - Portuguese Version Ana Serra, Maria Matos, Luís Jesus P65 Study of biochemical and haematological changes in football players Ana S. Tavares, Ana Almeida, Céu Leitão, Edna Varandas, Renato Abreu, Fernando Bellém P66 Body image dissatisfaction in inflammatory bowel disease: exploring the role of chronic illness-related shame Inês A. Trindade, Cláudia Ferreira, José Pinto-Gouveia, Joana Marta-Simões P67 Obesity and sleep in the adult population - a systematic review Odete Amaral, Cristiana Miranda, Pedro Guimarães, Rodrigo Gonçalves, Nélio Veiga, Carlos Pereira P68 Frequency of daytime sleepiness and obstructive sleep apnea risk in COPD patients Tânia C. Fleig, Elisabete A. San-Martin, Cássia L. Goulart, Paloma B. Schneiders, Natacha F. Miranda, Lisiane L. Carvalho, Andrea G. Silva P69 Working with immigrant-origin clients: discourses and practices of health professionals Joana Topa, Conceição Nogueira, Sofia Neves P70 Systemic Lupus Erythematosus – what are audiovestibular changes? Rita Ventura, Cristina Nazaré P71 Mental disorders in the oldest old: findings from the Portuguese national hospitalization database Daniela Brandão, Alberto Freitas, Óscar Ribeiro, Constança Paúl P72 Recurrence analysis in postural control in children with cerebral palsy Cristiana Mercê, Marco Branco, Pedro Almeida, Daniela Nascimento, Juliana Pereira, David Catela P73 The experience of self-care in the elderly with COPD: contributions to reflect proximity care Helga Rafael P74 Culturally competent nurses: managing unpredictability in clinical practice with immigrants Alcinda C. Reis O137 Paediatric speech and language screening: An instrument for health professionals Ana Mendes, Ana R. Valente, Marisa Lousada O138 Anthropometric and nutritional assessment in bodybuilders Diana Sousa, Ana L. Baltazar, Mª Helena Loureiro O139 Computerized adventitious respiratory sounds in children with lower respiratory tract infections Ana Oliveira, José Aparício, Alda Marques O140 Role of computerized respiratory sounds as a marker in LRTI Alda Marques, Ana Oliveira, Joana Neves, Rodrigo Ayoub O141 Confirmatory factor analysis of the Personal Wellbeing Index in people with chronic kidney disease Luís Sousa, Cristina Marques-Vieira, Sandy Severino, Helena José O142 Phonological awareness skills in school aged children Inês Cadorio, Marisa Lousada O143 Assessment of early memories of warmth and safeness in interaction with peers: its relationship with psychopathology in adolescence Marina Cunha, Diogo Andrade, Ana Galhardo, Margarida Couto O144 The molecular effects induced by single shot irradiation on a diffuse large B cell lymphoma cell line Fernando Mendes, Cátia Domingues, Susann Schukg, Ana M. Abrantes, Ana C. Gonçalves, Tiago Sales, Ricardo Teixo, Rita Silva, Jéssica Estrela, Mafalda Laranjo, João Casalta-Lopes, Clara Rocha, Paulo C. Simões, Ana B. Sarmento-Ribeiro, Mª Filomena Botelho, Manuel S. Rosa O145 Morpho-functional characterization of cardiac chambers by Transthoracic Echocardiography, in young athletes of gymnastics competition Virgínia Fonseca, Diogo Colaço, Vanessa Neves O146 Prevalence of the antibodies of the new histo-blood system – FORS system Carlos Jesus, Camilla Hesse, Clara Rocha, Nádia Osório, Ana Valado, Armando Caseiro, António Gabriel, Lola Svensson, Fernando Mendes, Wafa A. Siba, Cristina Pereira, Jorge Tomaz O147 Assessment of the war-related perceived threat in Portuguese Colonial War Veterans Teresa Carvalho, José Pinto-Gouveia, Marina Cunha O148 Pulse transit time estimation for continuous blood pressure measurement: A comparative study Diana Duarte, Nuno V. Lopes, Rui Fonseca-Pinto O149 Blood pressure assessment during standard clinical manoeuvres: A non-invasive PPT based approach Diana Duarte, Nuno V. Lopes, Rui Fonseca-Pinto O150 Development and initial validation of the Activities and Participation Profile related to Mobility (APPM) Anabela C. Martins O151 MEASYCare-2010 Standard–A geriatric evaluation system in primary health care: Reliability and validity of the latest version in Portugal Piedade Brandão, Laura Martins, Margarida Cardoso O152 Interrater and intrarater reliability and agreement of the range of shoulder flexion in the standing upright position through photographic assessment Nuno Morais, Joana Cruz O153 Three-dimensional biofabrication techniques for tissue regeneration Nuno Alves, Paula Faria, Artur Mateus, Pedro Morouço O154 A new computer tool for biofabrication applied to tissue engineering Nuno Alves, Nelson Ferreira, Artur Mateus, Paula Faria, Pedro Morouço O155 Development and psychometric qualities of a scale to measure the functional independence of adolescents with motor impairment Isabel Malheiro, Filomena Gaspar, Luísa Barros O156 Organizational Trust in Health services: Exploratory and Confirmatory factor analysis of the Organizational Trust Inventory- Short Form (OTI-SF) Pedro Parreira, Andreia Cardoso, Lisete Mónico, Carla Carvalho, Albino Lopes, Anabela Salgueiro-Oliveira O157 Thermal symmetry: An indicator of occupational task asymmetries in physiotherapy Adérito Seixas, Valter Soares, Tiago Dias, Ricardo Vardasca, Joaquim Gabriel, Sandra Rodrigues O158 A study of ICT active monitoring adoption in stroke rehabilitation Hugo Paredes, Arsénio Reis, Sara Marinho, Vítor Filipe, João Barroso O159 Paranoia Checklist (Portuguese Version): Preliminary studies in a mixed sample of patients and healthy controls Carolina Da Motta, Célia B. Carvalho, José Pinto-Gouveia, Ermelindo Peixoto O160 Reliability and validity of the Composite Scale on Morningness: European Portuguese version, in adolescents and young adults Ana A. Gomes, Vanessa Costa, Diana Couto, Daniel R. Marques, José A. Leitão, José Tavares, Maria H. Azevedo, Carlos F. Silva O161 Evaluation scale of patient satisfaction with nursing care: Psychometric properties evaluation João Freitas, Pedro Parreira, João Marôco O162 Impact of fibromyalgia on quality of life: Comparing results from generic instruments and FIQR Miguel A. Garcia-Gordillo, Daniel Collado-Mateo, Gang Chen, Angelo Iezzi, José A. Sala, José A. Parraça, Narcis Gusi O163 Preliminary study of the adaptation and validation of the Rating Scale of Resilient Self: Resilience, self-harm and suicidal ideation in adolescents Jani Sousa, Mariana Marques, Jacinto Jardim, Anabela Pereira, Sónia Simões, Marina Cunha O164 Development of the first pressure ulcer in inpatient setting: Focus on length of stay Pedro Sardo, Jenifer Guedes, João Lindo, Paulo Machado, Elsa Melo O165 Forms of Self-Criticizing and Self-Reassuring Scale: Adaptation and early findings in a sample of Portuguese children Célia B. Carvalho, Joana Benevides, Marina Sousa, Joana Cabral, Carolina Da Motta O166 Predictive ability of the Perinatal Depression Screening and Prevention Tool – Preliminary results of the dimensional approach Ana T. Pereira, Sandra Xavier, Julieta Azevedo, Elisabete Bento, Cristiana Marques, Rosa Carvalho, Mariana Marques, António Macedo O167 Psychometric properties of the BaSIQS-Basic Scale on insomnia symptoms and quality of sleep, in adults and in the elderly Ana M. Silva, Juliana Alves, Ana A. Gomes, Daniel R. Marques, Mª Helena Azevedo, Carlos Silva O168 Enlightening the human decision in health: The skin melanocytic classification challenge Ana Mendes, Huei D. Lee, Newton Spolaôr, Jefferson T. Oliva, Wu F. Chung, Rui Fonseca-Pinto O169 Test-retest reliability household life study and health questionnaire Pomerode (SHIP-BRAZIL) Keila Bairros, Cláudia D. Silva, Clóvis A. Souza, Silvana S. Schroeder O170 Characterization of sun exposure behaviours among medical students from Nova Medical School Elsa Araújo, Helena Monteiro, Ricardo Costa, Sara S. Dias, Jorge Torgal O171 Spirituality in pregnant women Carolina G. Henriques, Luísa Santos, Elisa F. Caceiro, Sónia A. Ramalho O172 Polypharmacy in older patients with cancer Rita Oliveira, Vera Afreixo, João Santos, Priscilla Mota, Agostinho Cruz, Francisco Pimentel O173 Quality of life of caregivers of people with advanced chronic disease: Translation and validation of the quality of life in life threatening illness - family carer version (QOLLTI-C-PT) Rita Marques, Mª Anjos Dixe, Ana Querido, Patrícia Sousa O174 The psychometric properties of the brief Other as Shamer Scale for Children (OAS-C): preliminary validation studies in a sample of Portuguese children Joana Benevides, Carolina Da Motta, Marina Sousa, Suzana N. Caldeira, Célia B. Carvalho O175 Measuring emotional intelligence in health care students – Revalidation of WLEIS-P Ana Querido, Catarina Tomás, Daniel Carvalho, João Gomes, Marina Cordeiro O176 Health indicators in prenatal assistance: The impact of computerization and of under-production in basic health centres Joyce O. Costa, Frederico C. Valim, Lígia C. Ribeiro O177 Hope genogram: Assessment of resources and interaction patterns in the family of the child with cerebral palsy Zaida Charepe, Ana Querido, Mª Henriqueta Figueiredo O178 The influence of childbirth type in postpartum quality of life Priscila S. Aquino, Samila G. Ribeiro, Ana B. Pinheiro, Paula A. Lessa, Mirna F. Oliveira, Luísa S. Brito, Ítalo N. Pinto, Alessandra S. Furtado, Régia B. Castro, Caroline Q. Aquino, Eveliny S. Martins O179 Women’s beliefs about pap smear test and cervical cancer: influence of social determinants Ana B Pinheiro, Priscila S. Aquino, Lara L. Oliveira, Patrícia C. Pinheiro, Caroline R. Sousa, Vívien A. Freitas, Tatiane M. Silva, Adman S. Lima, Caroline Q. Aquino, Karizia V. Andrade, Camila A. Oliveira, Eglidia F. Vidal O180 Validity of the Portuguese version of the ASI-3: Is anxiety sensitivity a unidimensional or multidimensional construct? Ana Ganho-Ávila, Mariana Moura-Ramos, Óscar Gonçalves, Jorge Almeida O181 Lifestyles of higher education students: the influence of self-esteem and psychological well-being Armando Silva, Irma Brito, João Amado P75 Assessing the quality of life of persons with significant intellectual disability: Portuguese version of Escala de San Martín António Rodrigo, Sofia Santos, Fernando Gomes P76 Childhood obesity and breastfeeding - A systematic review Marlene C. Rosa, Silvana F. Marques P77 Cross-cultural adaptation of the Foot and Ankle Ability Measure (FAAM) for the Portuguese population Sara Luís, Luís Cavalheiro, Pedro Ferreira, Rui Gonçalves P78 Cross-cultural adaptation of the Patient-Rated Wrist Evaluation score (PRWE) for the Portuguese population Rui S. Lopes, Luís Cavalheiro, Pedro Ferreira, Rui Gonçalves P79 Cross-cultural adaptation of the Myocardial Infraction Dimensional Assessment Scale (MIDAS) for Brazilian Portuguese language Bruno H. Fiorin, Marina S. Santos, Edmar S. Oliveira, Rita L. Moreira, Elizabete A. Oliveira, Braulio L. Filho P80 The revised Portuguese version of the Three-Factor Eating Questionnaire: A confirmatory factor analysis Lara Palmeira, Teresa Garcia, José Pinto-Gouveia, Marina Cunha P81 Assessing weight-related psychological inflexibility: An exploratory factor analysis of the AAQW’s Portuguese version Sara Cardoso, Lara Palmeira, Marina Cunha; José Pinto-Gouveia P82 Validation of the Body Appreciation Scale-2 for Portuguese women Joana Marta-Simões, Ana L. Mendes, Inês A. Trindade, Sara Oliveira, Cláudia Ferreira P83 The Portuguese validation of the Dietary Intent Scale Ana L. Mendes, Joana Marta-Simões, Inês A. Trindade, Cláudia Ferreira P84 Construction and validation of the Inventory of Marital Violence (IVC) Filipe Nave P85 Portable continuous blood pressure monitor system Mariana Campos, Iris Gaudêncio, Fernando Martins, Lino Ferreira, Nuno Lopes, Rui Fonseca-Pinto P86 Construction and validation of the Scale of Perception of the Difficulties in Caring for the Elderly (SPDCE) Rogério Rodrigues, Zaida Azeredo, Corália Vicente P87 Development and validation of a comfort rating scale for the elderly hospitalized with chronic illness Joana Silva, Patrícia Sousa, Rita Marques P88 Construction and validation of the Postpartum Paternal Quality of Life Questionnaire (PP-QOL) Isabel Mendes, Rogério Rodrigues, Zaida Azeredo, Corália Vicente P89 Infrared thermal imaging: A tool for assessing diabetic foot ulcers Ricardo Vardasca, Ana R. Marques, Adérito Seixas, Rui Carvalho, Joaquim Gabriel P90 Pressure ulcers in an intensive care unit: An experience report Paulo P. Ferreira, Michelle T. Oliveira, Anderson R. Sousa, Ana S. Maia, Sebastião T. Oliveira, Pablo O. Costa, Maiza M. Silva P91 Validation of figures used in evocations: instrument to capture representations Cristina Arreguy-Sena, Nathália Alvarenga-Martins, Paulo F. Pinto, Denize C. Oliveira, Pedro D. Parreira, Antônio T. Gomes, Luciene M. Braga P92 Telephone assistance to decrease burden in informal caregivers of stroke older people: Monitoring and diagnostic evaluation Odete Araújo, Isabel Lage, José Cabrita, Laetitia Teixeira P93 Hope of informal caregivers of people with chronic and advanced disease Rita Marques, Mª Anjos Dixe, Ana Querido, Patrícia Sousa P94 Functionality and quality information from the Portuguese National Epidemiological Surveillance System Sara Silva, Eugénio Cordeiro, João Pimentel P95 Resting metabolic rate objectively measured vs. Harris and Benedict formula Vera Ferro-Lebres, Juliana A. Souza, Mariline Tavares O182 Characteristics of non-urgent patients: Cross-sectional study of an emergency department Mª Anjos Dixe, Pedro Sousa, Rui Passadouro, Teresa Peralta, Carlos Ferreira, Georgina Lourenço O183 Physical fitness and health in children of the 1st Cycle of Education João Serrano, João Petrica, Rui Paulo, Samuel Honório, Pedro Mendes O184 The impact of physical activity on sleep quality, in children Alexandra Simões, Lucinda Carvalho, Alexandre Pereira O185 What is the potential for using Information and Communication Technologies in Arterial Hypertension self-management? Sara Silva, Paulino Sousa, José M. Padilha O186 Exploring psychosocial factors associated with risk of falling in older patients undergoing haemodialysis Daniela Figueiredo, Carolina Valente, Alda Marques O187 Development of pressure ulcers on the face in patients undergoing non-invasive ventilation Patrícia Ribas, Joana Sousa, Frederico Brandão, Cesar Sousa, Matilde Martins O188 The elder hospitalized: Limiting factors of comfort Patrícia Sousa, Rita Marques O189 Physical activity and health state self-perception by Portuguese adults Francisco Mendes, Rosina Fernandes, Emília Martins, Cátia Magalhães, Patrícia Araújo O190 Satisfaction with social support in the elderly of the district of Bragança Carla Grande, Mª Augusta Mata, Juan G. Vieitez O191 Prevalence of death by traumatic brain injury and associated factors in intensive care unit of a general hospital, Brazil Bruna Bianchini, Nazare Nazario, João G. Filho, Marcia Kretzer O192 Relation between family caregivers burden and health status of elderly dependents Tânia Costa, Armando Almeida, Gabriel Baffour O193 Phenomena sensitive to nursing care in day centre Armando Almeida, Tânia Costa, Gabriel Baffour O194 Frailty: what do the elderly think? Zaida Azeredo, Carlos Laranjeira, Magda Guerra, Ana P. Barbeiro O195 The therapeutic self-care as a nursing-sensitive outcome: A correlational study Regina Ferreira O196 Phonetic-phonological acquisition for the European Portuguese from 18 months to 6 years and 12 months Sara Lopes, Liliana Nunes, Ana Mendes O197 Quality of life of patients undergoing liver transplant surgery Julian Martins, Dulcineia Schneider, Marcia Kretzer, Flávio Magajewski O198 Professional competences in health: views of older people from different European Countries Célia Soares, António Marques O199 Life satisfaction of working adults due to the number of hours of weekly exercise Marco Batista, Ruth J. Castuera, Helena Mesquita, António Faustino, Jorge Santos, Samuel Honório O200 Therapeutic itinerary of women with breast cancer in Santa Maria City/RS Betina P. Vizzotto, Leticia Frigo, Hedioneia F. Pivetta O201 The breastfeeding prevalence at 4 months: Maternal experience as a determining factor Dolores Sardo O202 The impact of the transition to parenthood in health and well-being Cristina Martins, Wilson Abreu, Mª Céu Figueiredo P96 Self-determined motivation and well-being in Portuguese active adults of both genders Marco Batista, Ruth Jimenez-Castuera, João Petrica, João Serrano, Samuel Honório, Rui Paulo, Pedro Mendes P97 The geriatric care: ways and means of comforting Patrícia Sousa, Rita Marques P98 The influence of relative age, subcutaneous adiposity and physical growth on Castelo Branco under-15 soccer players 2015 António Faustino, Paulo Silveira, João Serrano, Rui Paulo, Pedro Mendes, Samuel Honório P99 Data for the diagnostic process focused on self-care – managing medication regime: An integrative literature review Catarina Oliveira, Fernanda Bastos, Inês Cruz P100 Art therapy as mental health promotion for children Cláudia K. Rodriguez, Márcia R. Kretzer, Nazaré O. Nazário P101 Chemical characterization of fungal chitosan for industrial applications Pedro Cruz, Daniela C. Vaz, Rui B. Ruben, Francisco Avelelas, Susana Silva, Mª Jorge Campos P102 The impact of caring older people at home Maria Almeida, Liliana Gonçalves, Lígia Antunes P103 Development of the first pressure ulcer in an inpatient setting: Focus on patients’ characteristics Pedro Sardo, Jenifer Guedes, João Simões, Paulo Machado, Elsa Melo P104 Association between General Self-efficacy and Physical Activity among Adolescents Susana Cardoso, Osvaldo Santos, Carla Nunes, Isabel Loureiro O203 Characterization of the habits of online acquisition of medicinal products in Portugal Flávia Santos, Gilberto Alves O204 Waiting room – A space for health education Cláudia Soar, Teresa O. Marsi O205 Safey culture evaluation in hospitalized children Ernestina Silva, Dora Pedrosa, Andrea Leça, Daniel Silva O206 Sexual Self-awareness and Body Image Ana Galvão, Maria Gomes, Paula Fernandes, Ana Noné O207 Perception of a Portuguese population regarding the acquisition and consumption of functional foods Jaime Combadão, Cátia Ramalhete, Paulo Figueiredo, Patrícia Caeiro O208 The work process in primary health care: evaluation in municipalities of southern Brazil Karine C. Fontana, Josimari T. Lacerda, Patrícia O. Machado O209 Exploration and evaluation of potential probiotic lactic acid bacteria isolated from Amazon buffalo milk Raphaelle Borges, Flávio Barbosa, Dayse Sá O210 Road safety for children: Using children’s observation, as a passenger Germana Brunhoso, Graça Aparício, Amâncio Carvalho O211 Perception and application of quality-by-design by the Pharmaceutical industry in Portugal Ana P. Garcia, Paula O. Fernandes, Adriana Santos O212 Oral health among Portuguese children and adolescents: a public health issue Nélio Veiga, Carina Brás, Inês Carvalho, Joana Batalha, Margarida Glória, Filipa Bexiga, Inês Coelho, Odete Amaral, Carlos Pereira O213 Plant species as a medicinal resource in Igatu-Chapada Diamantina (Bahia, Brazil) Cláudia Pinho, Nilson Paraíso, Ana I. Oliveira, Cristóvão F. Lima, Alberto P. Dias O214 Characterization of cognitive and functional performance in everyday tasks: Implications for health in institutionalised older adults Pedro Silva, Mário Espada, Mário Marques, Ana Pereira O215 BMI and the perception of the importance given to sexuality in obese and overweight people Ana Mª Pereira, Mª Veiga-Branco, Filomena Pereira, Maria Ribeiro O216 Analysis and comparison of microbiological contaminations of two different composition pacifiers Vera Lima, Ana I. Oliveira, Cláudia Pinho, Graça Cruz, Rita F. Oliveira, Luísa Barreiros, Fernando Moreira O217 Experiences of couple relationships in the transition to retirement Ana Camarneiro, Mª Helena Loureiro, Margarida Silva O218 Preventive and corrective treatment of drug-induced calcium deficiency: an analysis in a community pharmacy setting Catarina Duarte, Ângelo Jesus, Agostinho Cruz O219 Profile of mood states in physically active elderly subjects: Is there a relation with health perception? Maria Mota, Sandra Novais, Paulo Nogueira, Ana Pereira, Lara Carneiro, Paulo V. João O220 (Un)Safety behaviour at work: the role of education towards a health and safety culture Teresa Maneca Lima O221 Analysis of the entrepreneurial profile of students attending higher education in Portugal: the Carland Entrepreneurship Index application Anabela Salgueiro-Oliveira, Marina Vaquinhas, Pedro Parreira, Rosa Melo, João Graveto, Amélia Castilho, José H. Gomes O222 Evaluation of welfare and quality of life of pregnant working women regarding the age of the pregnant María S. Medina, Valeriana G. Blanco O223 Psychological wellbeing protection among unemployed and temporary workers: Uncovering effective community-based interventions with a Delphi panel Osvaldo Santos, Elisa Lopes, Ana Virgolino, Alexandra Dinis, Sara Ambrósio, Inês Almeida, Tatiana Marques, Mª João Heitor O224 Chilean population norms derived from the Health-related quality of life SF-6D Miguel A. Garcia-Gordillo, Daniel Collado-Mateo, Pedro R. Olivares, José A. Parraça, José A. Sala O225 Motivation of college students toward Entrepreneurship: The influence of social and economic instability Amélia Castilho, João Graveto, Pedro Parreira, Anabela Oliveira, José H. Gomes, Rosa Melo, Marina Vaquinhas O226 Use of aromatic and medicinal plants, drugs and herbal products in Bragança city Mónia Cheio, Agostinho Cruz, Olívia R. Pereira O227 Edible flowers as new novel foods concept for health promotion Sara Pinto, Adriana Oliveira, M. Conceição Manso, Carla Sousa, Ana F. Vinha O228 The influence of leisure activities on the health and welfare of older people living in nursing homes Mª Manuela Machado, Margarida Vieira O229 Risk of falling, fear of falling and functionality in community-dwelling older adults Beatriz Fernandes, Teresa Tomás, Diogo Quirino O230 Musculoskeletal pain and postural habits in children and teenage students Gustavo Desouzart, Rui Matos, Magali Bordini, Pedro Mouroço O231 What's different in Southern Europe? The question of citizens’ participation in health systems Ana R. Matos, Mauro Serapioni O232 Occupational stress in Portuguese police officers Teresa Guimarães, Virgínia Fonseca, André Costa, João Ribeiro, João Lobato O233 Is occupational therapy culturally relevant to promote mental health in Burkina Faso? Inmaculada Z. Martin, Anita Björklund P105 Pay-for-performance satisfaction and quality in primary care Aida I. Tavares, Pedro Ferreira, Rui Passadouro P106 Economic development through life expectancy lenses Sónia Morgado P107 What is the effectiveness of exercise on smoking cessation to prevent clinical complications of smoking? Nuno Tavares, João Valente, Anabela C. Martins P108 A systematic review of the effects of yoga on mental health Patrícia Araújo, Rosina Fernandes, Francisco Mendes, Cátia Magalhães, Emília Martins P109 Healthy lifestyle: comparison between higher education students that lived until adult age in rural and urban environment Pedro Mendes, Rui Paulo, António Faustino, Helena Mesquita, Samuel Honório, Marco Batista P110 Evaluation of the Mobile Emergency Care Service (SAMU) in Brazil Josimari T. Lacerda, Angela B. Ortiga, Mª Cristina Calvo, Sônia Natal P111 Bioactive compounds - antioxidant activity of tropical fruits Marta Pereira P112 Use of non-pharmacological methods to relieve pain in labour Manuela Ferreira, Ana R. Prata, Paula Nelas, João Duarte P113 Mechanical safety of pacifiers sold in Portuguese pharmacies and childcare stores Juliana Carneiro, Ana I. Oliveira, Cláudia Pinho, Cristina Couto, Rita F. Oliveira, Fernando Moreira P114 The importance of prenatal consultation: Information to pregnant women given on a unit of primary care Ana S. Maia, Michelle T. Oliveira, Anderson R. Sousa, Paulo P. Ferreira, Géssica M. Souza, Lívia F. Almada, Milena A. Conceição, Eujcely C. Santiago P115 Influence of different backpack loading conditions on neck and lumbar muscles activity of elementary school children Sandra Rodrigues, Gabriela Domingues, Irina Ferreira, Luís Faria, Adérito Seixas P116 Efficacy and safety of dry extract Hedera helix in the treatment of productive cough Ana R. Costa, Ângelo Jesus, Américo Cardoso, Alexandra Meireles, Armanda Colaço, Agostinho Cruz P117 A portrait of the evaluation processes of education groups in primary health care Viviane L. Vieira, Kellem R. Vincha, Ana Mª Cervato-Mancuso P118 Benefits of vitamins C and E in sensorineural hearing loss: a review Melissa Faria, Cláudia Reis P119 BODY SNAPSHOT – a web-integrated anthropometric evaluation system Marco P. Cova, Rita T. Ascenso, Henrique A. Almeida, Eunice G. Oliveira P120 Anthropometric evaluation and variation during pregnancy Miguel Santana, Rafael Pereira, Eunice G. Oliveira, Henrique A. Almeida, Rita T. Ascenso P121 Knowledge of college students on the amendments of their eating habits and physical activity index in the transition to higher education Rita Jesus, Rodrigo Tapadas, Carolina Tim-Tim, Catarina Cezanne, Matilde Lagoa, Sara S. Dias, Jorge Torgal P122 Muscular activity of a rally race car driver João Lopes, Henrique Almeida, Sandra Amado, Luís Carrão O234 Literacy and results in health Madalena Cunha, Luís Saboga-Nunes, Carlos Albuquerque, Olivério Ribeiro O235 Literacy promotion and empowerment of type 2 diabetics elderly in four family health units of the group of health centers of Dão Lafões Suzete Oliveira, Mª Carminda Morais O236 Mediterranean diet, health and life quality among Portuguese children Emília Martins, Francisco Mendes, Rosina Fernandes, Cátia Magalhães, Patrícia Araújo O237 Health literacy, from data to action - translation, validation and application of the European Health Literacy Survey in Portugal (HLS-EU-PT) Ana R. Pedro, Odete Amaral, Ana Escoval O238 Oral health literacy evaluation in a Portuguese military population Victor Assunção, Henrique Luís, Luís Luís O239 Preferences to Internet-based cognitive behavioural therapy – do attachment orientations matter? Jennifer Apolinário-Hagen, Viktor Vehreschild O240 A comparative transnational study in health literacy between Austria and Portugal Ulrike Fotschl, Gerald Lirk, Anabela C. Martins, Isabel Andrade, Fernando Mendes O241 Health literacy and social behaviours: relationship with sexually transmitted diseases? Verónica Mendonça, Sandra Antunes, Isabel Andrade, Nádia Osório, Ana Valado, Armando Caseiro, António Gabriel, Anabela C. Martins, Fernando Mendes O242 Parenting styles and attachment to parents: what relationships? Paula A. Silva, Lisete M. Mónico, Pedro M. Parreira, Carla Carvalho O243 Work-life balance in health professionals and professors: comparative study of workers with shift work and fixed schedule Carla Carvalho, Pedro M. Parreira, Lisete M. Mónico, Joana Ruivo O244 Technology literacy in self-management of diabetes Vânia Silva, Paulino Sousa, José M. Padilha O245 Satisfaction with therapeutic education and its relationship with clinical variables in children with type 1 diabetes Vera Ferraz, Graça Aparício, João Duarte O246 Nutrition-related knowledge in middle-age and older patients with type 2 diabetes Carlos Vasconcelos, António Almeida, Joel Neves, Telma Correia, Helena Amorim, Romeu Mendes O247 Validating the HLS-EU-(PT) questionnaire to measure health literacy in adolescents (CrAdLiSa project: HLS-EU-PT) Luís Saboga-Nunes, Madalena Cunha, Carlos Albuquerque O248 Health education in people with coronary heart disease: Experience of the cardiology department of a hospital on the outskirts of Lisbon Elsa S. Pereira, Leonino S. Santos, Ana S. Reis, Helena R. Silva, João Rombo, Jorge C. Fernandes, Patrícia Fernandes O249 Information and training needs of informal caregivers of individuals with stroke sequelae: a qualitative survey Jaime Ribeiro, Catarina Mangas, Ana Freire O250 Prevention of psychoactive substances consumption in students from 6th grade of Albergaria-a-Velha´s School Group Sara Silva, Irene Francisco, Ana Oliveira O251 Promoting healthy sexuality: shared responsibility for family, youth and educators Helena Catarino, Mª Anjos Dixe, Mª Clarisse Louro O252 Sexual risk behaviour in adolescents and young people Saudade Lopes, Anjos Dixe O253 Knowledge of school staff on type 1 diabetes Mª Anjos Dixe, Eva Menino, Helena Catarino, Fátima Soares, Ana P. Oliveira, Sara Gordo, Teresa Kraus O254 Sexual health in adolescents: the impact of information search in literacy Catarina Tomás, Paulo Queirós, Teresa Rodrigues P123 Improving basic life support skills in adolescents through a training programme Pedro Sousa, João G. Frade, Catarina Lobão P124 Difficulties in sexual education reported by basic education teachers in the city of Foz do Iguaçu - Brazil Cynthia B. Moura, Laysa C. Dreyer, Vanize Meneghetti, Priscila P. Cabral P125 Breast cancer survivors: subjects and resources for information. A qualitative systematic review Francisca Pinto, Paulino Sousa, Mª Raquel Esteves P126 Relationship between health literacy and prevalence of STI in Biomedical Laboratory Science students Sofia Galvão, Ite Tytgat, Isabel Andrade, Nádia Osório, Ana Valado, Armando Caseiro, António Gabriel, Anabela C. Martins, Fernando Mendes P127 Health literacy, risk behaviours and sexually transmitted diseases among blood donors Mónica Casas-Novas, Helena Bernardo, Isabel Andrade, Gracinda Sousa, Ana P. Sousa, Clara Rocha, Pedro Belo, Nádia Osório, Ana Valado, Armando Caseiro, António Gabriel, Anabela C. Martins, Fernando Mendes P128 Promoting literacy in pregnancy health-care Fátima Martins, Montserrat Pulido-Fuentes P129 The lifestyles of the operating assistants of education Isabel Barroso, Gil Cabral, M. João Monteiro, Conceição Rainho P130 Experiences of service-learning health and the literary art: reflections about the health education Alessandro Prado, Yara M. Carvalho P131 Life long swimming – a European Erasmus + project Maria Campos, Liliana Moreira, José Ferreira, Ana Teixeira, Luís Rama

Mechanical ventilation is a useful treatment option for respiratory insufficiency following thoracic and cardiovascular surgery. Ventilation mode is classified as volume-controlled-ventilation(VCV) and pressure-controlled ventilation(PCV). Non-invasive ventilation(NIV) without tracheal intubation has been recently developed and is effective in patients with chronic obstructive pulmonary disease (COPD) exacerbation. Several pulmonary complications by mechanical ventilation such as ventilator-induced lung injury(VILI) or ventilator-associated pneumonia(VAP) could be avoided with NIV. According to the protocol published from Japanese Society of Intensive Care Unit, Japanese Society of Respiratory Care Medicine, and Japan Academy of Critical Care Nursing, both spontaneous awakening trial(SAT) and spontaneous breathing trial(SBT) are recommended at the weaning from mechanical ventilation. I herein describe the utility of mechanical ventilation in patients with major pulmonary resection, myasthenia gravis, lung transplantation, and cardiac surgery, for each. We should understand not only the utility but also the non-physiological condition during mechanical ventilation.

The impact of awake prone positioning (APP) on clinical outcomes in patients with COVID-19 and acute hypoxemic respiratory failure (AHRF) remains uncertain. To assess the association of APP with improved clinical outcomes among patients with COVID-19 and AHRF, and to identify potential effect modifiers. PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched through August 1, 2024. Randomized clinical trials (RCTs) examining APP in adults with COVID-19 and AHRF that reported intubation rate or mortality were included. Individual participant data (IPD) were extracted according to PRISMA-IPD guidelines. For binary outcomes, logistic regression was used and odds ratio (OR) and 95% CIs were reported, while for continuous outcomes, linear regression was used and mean difference (MD) and 95% CIs were reported. The primary outcome was survival without intubation. Secondary outcomes included intubation, mortality, death without intubation, death after intubation, escalation of respiratory support, intensive care unit (ICU) admission, time from enrollment to intubation and death, duration of invasive mechanical ventilation, and hospital and ICU lengths of stay. A total of 14 RCTs involving 3019 patients were included; 1542 patients in the APP group (mean [SD] age, 59.3 [14.1] years; 1048 male [68.0%]) and 1477 in the control group (mean [SD] age, 59.9 [14.1] years; 979 male [66.3%]). APP improved survival without intubation (OR, 1.42; 95% CI, 1.20-1.68), and it reduced the risk of intubation (OR, 0.70; 95% CI, 0.59-0.84) and hospital mortality (OR, 0.77; 95% CI, 0.63-0.95). APP also extended the time from enrollment to intubation (MD, 0.93 days; 95% CI, 0.43 to 1.42 days). In exploratory subgroup analyses, improved survival without intubation was observed in patients younger than age 68 years, as well as in patients with a body mass index of 26 to 30, early implementation of APP (ie, less than 1 day from hospitalization), a pulse saturation to inhaled oxygen fraction ratio of 155 to 232, respiratory rate of 20 to 26 breaths per minute (bpm), and those receiving advanced respiratory support at enrollment. However, none of the subgroups had significant interaction with APP treatment. APP duration 10 or more hours/d within the first 3 days was associated with increased survival without intubation (OR, 1.85; 95% CI, 1.37-2.49). This IPD meta-analysis found that in adults with COVID-19 and AHRF, APP was associated with increased survival without intubation and with reduced risks of intubation and mortality, including death after intubation. Prolonged APP duration (10 or more hours/d) was associated with better outcomes.

Patients with COPD experience acute worsenings, termed 'exacerbations'. While other terms to describe these events have been proposed there is no consensus on terminology which has led to multiple terms being used across the UK. Respiratory nurses are part of a multi-disciplinary team managing COPD patients, however, the nursing perspective on the term 'exacerbation' is unknown. An anonymised survey of 17 questions was sent to respiratory nurses through an email invitation link. The survey link was open for one month. The aim was to understand the nurse perspective on 'exacerbation'. Alternative terms used in the UK were compared versus the term 'exacerbation'. Responses were received from 113 nurses. The majority (88%) were female. There was no consensus on preference or meaning for the term 'exacerbation' between nurses. Less than 5% of nurses thought that patients with COPD would understand the term 'exacerbation'. In ranked order, the nurses preferred the following terms: 'flare-up', 'lung attack', 'crisis', 'exacerbation' and 'chest infection'. The term 'crisis', although new, was considered to be the term that most resonated with clinical practice. Respiratory nurses in the UK report that the term 'exacerbation' is not fit for purpose for patients, and alternatives should be sought.

Studies conducted during the COVID-19 pandemic have shown that crowding in nursing homes is associated with high incidence of SARS-CoV-2 infections, but this effect has not been shown for other respiratory pathogens. We aimed to measure the association between crowding in nursing homes and outbreak-associated respiratory infection incidence and related mortality before the COVID-19 pandemic. We conducted a retrospective cohort study of nursing homes in Ontario, Canada. We identified, characterised, and selected nursing homes through the Ontario Ministry of Long-Term Care datasets. Nursing homes that were not funded by the Ontario Ministry of Long-Term Care and homes that closed before January, 2020 were excluded. Outcomes consisting of respiratory infection outbreaks were obtained from the Integrated Public Health Information System of Ontario. The crowding index equalled the mean number of residents per bedroom and bathroom. The primary outcomes were the incidence of outbreak-associated infections and mortality per 100 nursing home residents per year. We examined the incidence of infections and deaths as a function of the crowding index by use of negative binomial regression with adjustment for three home characteristics (ie, ownership, number of beds, and region) and nine mean resident characteristics (ie, age, female sex, dementia, diabetes, chronic heart failure, renal failure, cancer, chronic obstructive pulmonary disease, and activities of daily living score). Between Sept 1, 2014, and Aug 31, 2019, 5107 respiratory infection outbreaks in 588 nursing homes were recorded, of which 4921 (96·4%), involving 64 829 cases of respiratory infection and 1969 deaths, were included in this analysis. Nursing homes with a high crowding index had higher incidences of respiratory infection (26·4% vs 13·8%; adjusted rate ratio per one resident per room increase in crowding 1·89 [95% CI 1·64-2·17]) and mortality (0·8% vs 0·4%; 2·34 [1·88-2·92]) than did homes with a low crowding index. Respiratory infection and mortality rates were higher in nursing homes with high crowding index than in homes with low crowding index, and the association was consistent across various respiratory pathogens. Decreasing crowding is an important safety target beyond the COVID-19 pandemic to help to promote resident wellbeing and decrease the transmission of prevalent respiratory pathogens. None.

To reach a multidisciplinary consensus on the management of patients with advanced COPD using Delphi methodology. A multidisciplinary committee of experts (Pneumology, Physiotherapy, Internal Medicine, Physical Medicine and Rehabilitation, Primary Care, and Nursing) developed a 105-item questionnaire to be agreed by a panel of experts grouped into the following topics: (1) Definition of advanced COPD patients; (2) Management of dyspnoea in patients with advanced COPD; (3) Prevention and recovery of exacerbation in patients with advanced COPD; and (4) Dealing with disease progression. After two rounds, consensus was reached on 77.1% of the items. The definition proposed for advanced COPD and agreed by 91.5% of the panellists stated: "COPD patient with FEV In this document, a broad panel of experts reached a high degree of consensus on the definition of advanced COPD as well as on its approach. The information provided by this consensus is intended to assist the clinician in the identification of these patients as well as to provide guidance on their management. Alcanzar un consenso multidisciplinar sobre el manejo de los pacientes con EPOC avanzada mediante la metodología Delphi. Un comité multidisciplinar de expertos (Neumología, Fisioterapia, Medicina Interna, Medicina Física y Rehabilitación, Atención Primaria y Enfermería) elaboró un cuestionario de 105 aseveraciones para ser consensuado por un panel de expertos agrupados en los siguientes temas: 1) Definición de pacientes con EPOC avanzada; 2) Manejo de la disnea en pacientes con EPOC avanzada; 3) Prevención y recuperación de la exacerbación en pacientes con EPOC avanzada; y 4) Afrontamiento de la progresión de la enfermedad. Tras dos rondas, se alcanzó un consenso en el 77,1% de las aseveraciones. La definición propuesta para EPOC avanzada y consensuada por el 91,5% de los panelistas establecía: “Paciente con EPOC con FEV En este documento, un amplio panel de expertos alcanzó un alto grado de consenso en lo que respecta a la definición de EPOC avanzada, así como en su abordaje. La información proporcionada por este consenso pretende ayudar al clínico en la identificación de estos pacientes, así como orientar sobre su manejo..

The spread of coronavirus disease 2019 (COVID-19) worldwide since November 2019 is of interest to understand its impact on various organs. COVID-19 patients experience a higher incidence of acute kidney injury (AKI) compared with non-COVID-19 patients. A systematic literature search was conducted that covered the period from November 1, 2019 to February 28, 2021. The analysis incorporated a comprehensive review of 19 studies of 21 362 patients. The older age (mean difference [MDs] = 5.11), cardiovascular disease (CVD) (odds ratio [OR] = 1.94), male sex (OR = 1.55), chronic kidney disease (CKD) (OR = 3.82), hypertension (OR = 2.15), diabetes (OR = 1.71), cancer (OR = 1.16), and chronic obstructive pulmonary disease (COPD) (OR = 1.40), mechanical ventilation (OR = 8.66), and vasopressor (OR = 6.30), were significantly associated with risk factor for AKI (P < 0.05). The analysis revealed independent risk factors for AKI.